Supporting Self Care Network
Newsletter
August 8, 2001, #1
Supporting Self Care : We Care...
Contents
Welcome
Editorial
Highlights
Member Profiles
In Practice
Sharing Resources
Welcome
by Jean-Marie Romeder, M.Sc, Ph.D, M.Ps, Health Canada
Welcome to the first e-newsletter of the Supporting Self-Care Network. I hope you enjoy the arious articles, which were mostly written by members of the Network Committee.
This issue also contains some highlights from the recent national Symposium on Supporting Self-Care. I found it particularly stimulating to hear many colleagues share their intentions to make special efforts back home to ensure that supporting self-care is better integrated into the practice and education of health professionals.
If you have any comments or suggestions on the newsletter, the Network website or the Network Directory, please send them to the Network coordinator, Isabelle Caron at [e-address was here]. We also welcome your contributions and ideas for future issues. The next issue is planned for the end of September 2001.
P.S. Isabelle is getting married on August 11 and then flying to France for a honeymoon and a well-deserved holiday. I am sure that those of you who know her join me in thanking her for all her good work during the past few months, and wish her the best for a wonderful future!
Editorial
Supporting Self-Care-Who Cares?
by Wayne Weston, MD, CCFP, FCFP, Family Medicine, University of Western Ontario
Is "supporting self care" just an empty slogan that sounds important, but is really a trick to download care onto the consumer? Or does it represent another way of providing care that values the patient/client as a vital partner?
The traditional model views the consumer as a novice who could never know enough of a professional's special knowledge to make an informed choice. "Good" consumers do what they are told; in health care, they follow "doctor's orders". This approach was common in the past. In fact, most medical schools taught physicians to take charge of patients' problems and make decisions for them. This is no longer acceptable.
Patients/clients now expect to be well enough informed to understand the disease process and the treatment recommendations. They want to be more involved in making decisions about prevention, and the investigation and management of their illnesses. They vote with their feet and their pocketbooks. Patients/clients are spending as much on complementary and alternative care as on traditional care. Some suggest that one reason for this is that alternative caregivers spend more time with their clients, listen carefully and provide more relevant information.
When patients/clients develop a good understanding of their illnesses, they are in a better position to manage their own care. For example, patients with diabetes may need to make adjustments in their treatment from time to time and should not be dependent on a physician or nurse to always decide for them. Patients can become expert in the unique ways in which their bodies react. Thus, they may be better able to make appropriate adjustments than a professional.
Health care professionals need a set of skills to support self-care. They must also embody a point-of-view and a set of values about the importance of supporting and encouraging patient autonomy.
The patient is the centre of care. His or her ideas, feelings, and expectations should be actively sought and addressed. The impact of illness on a patient's function should be considered, as well as the pathophysiology. Supporting self-care broadens the perspective and responsibility of health care professionals beyond the conventional biomedical model. As such, it provides a perspective that can be shared by a variety of disciplines and by patients themselves. By promoting an effective partnership with patients and among health care professionals, care can be less burdensome and more effective.
Patients/clients and their families may fear that supporting self-care might be used as a cost saving measure designed to download professional care onto them. But, abandoning patients and their families in the name of supporting self-care is morally unacceptable. Patients/clients and their families will continue to need timely access to health care services even as they become more skilled in participating in their own care. Nor, can we assume that supporting self-care will reduce costs. When the National Health Service was formed in Britain in the early 1900s, the planners were optimistic that widespread preventive practices would cut costs of care dramatically. It is now clear that quite often, prevention does not save health care dollars and, likely, neither will promoting self-care.
Supporting self-care is not an empty slogan. Who cares about supporting self-care? We all should because the purpose of supporting self-care is to improve the patient's/client's quality of life in a manner that is congruent with their personal values.
Highlights
The Supporting Self-Care Symposium, June 2001
Supporting Self-Care: A Shared Initiative, which was launched in June 1999, arrived at a turning point with the organization of an invitational symposium in Ottawa from June 2 to 4, 2001. Some 74 people attended.
Participants included representatives from the nine funded projects, Self-Care Coordinating Committee members, Supporting Self-Care Network Development Committee members and people invited by each of the partners of the Supporting Self Care Initiative (Canadian Nurses Association, College of Family Physicians of Canada, Association of Canadian Medical Colleges and Canadian Association of University Schools of Nursing).
The objectives of the symposium were to produce concrete recommendations in education, professional practice and policy in order to enhance the concept of self-care among professionals, to disseminate current experiences in various fields of supporting self-care, and to strengthen the self-care network. These objectives were met and surpassed.
Facilitator, Alan Sobel took the group through a process that culminated in recommendations related to practice, community and education. They will be analyzed by the Coordinating Committee in August 2001 in order to construct a framework for possible involvement of the partners and Health Canada in future phases. There were also 25 commitments to action.
Abby Hoffman, Director General, Health Policy and Communications Branch of Health Canada provided opening remarks and Robert McMurtry, Assistant Deputy Minister, Population and Public Health Branch of Health Canada provided closing comments.
The Supporting Self-Care Network Website was officially launched through a presentation and a reception and 30 people joined on the spot.
A full report from the Initiative and the Symposium should be available in both official languages by the end of 2001. Meanwhile, here are some "food for thought" quotes from participants:
"We need to build a community of care in our academic institutions, the health care system and greater society-an 'ethos of care' for ourselves and those we serve."
"The patient has a key role as teacher."
"Our project was a great interdisciplinary experience and an important first step for future projects."
"Action plans work. They provide a 'mind frame' and mechanism to focus your work."
"We need a system based on caring, instead of curing."
"Let's put the passion back in compassion."
"I am the main actor in my care."
"After the Symposium-report, reform and network!"
Member Profiles
Alain Vanasse, MD, Ph.D, Family Medicine, University of Sherbrooke
and Laurie Potovsky-Beachell, Consumer Advocate
Alain Vanasse and Laurie Potovsky-Beachell lead very different lives. But when it comes to their philosophies about supporting self-care, they have much in common.
As an assistant Professor in Family Medicine at the University of Sherbrooke, Alain spends half-time teaching and half-time in research work. Before joining the university, Alain spent some 20 years as a family physician and public health specialist in rural Quebec.
"If you believe in the concept of supporting self-care, you must respect and listen to your patients," says Alain. "This respect is the basis of a trusting relationship. Then, you can go further by delegating care to your patients and helping them learn how to manage their conditions. It takes time to use this approach and build this kind of a relationship."
"A 'self-care friendly' environment makes it easier to promote self-care behaviors." says Alain. "For example, if you tell drug users to use a sterile syringe, they must be able to access these syringes."
Laurie is a breast cancer survivor and an avid member of the Winnipeg breast cancer Dragon Boat racing team. Laurie was an advocate for patient partnerships with health professionals long before her diagnosis with breast cancer. Her experience with this illness confirmed her belief in the need for health professionals (including specialists) to better understand how to support self-care. "I was isolated and made to feel dissected and not a credible part of the team that was planning my treatment," says Laurie. "The aim must be to have a productive relationship between clients and professionals. This kind of a relationship has an emotional component that enables users to feel empowered and confident in their own ability to look after themselves. Respect and trust deepens over time, but it starts in the very first encounter, when a health care professional takes your views into account."
In Practice
A Program for Day Surgery Clients
by France L. Marquis, M.Sc.Inf., University of Moncton
This article describes a Day Surgery Perioperative Program focusing on self-care, including the development of information tools, one of which is the Health Calendar.
Users and health workers cooperated in developing the Health Calendar. It enables individuals to manage their own health during the day surgery process, and provides professionals with standardized self-care support measures they can use to help individuals in their progress toward autonomy. The Health Calendar includes activities and information on the three stages of the day surgery process: the period prior to surgery, the day before and the day of surgery, and the return home. In addition to the Health Calendar, each individual receives information pamphlets on preoperative hygiene, the types of anesthesia and the surgery being performed. Individuals also receive a telephone follow-up from a nurse 24 hours after their discharge to answer their questions and help them manage their recovery.
An evaluation of client satisfaction with the program had very positive results. All clients said they were satisfied or very satisfied with the information and support they received. They were able to manage most of their symptoms, including nausea, vomiting, headaches and urinary difficulties. The information they received and the telephone follow-up helped them control pain.
For their part, the health professionals considered the Day Surgery Perioperative Program useful and appropriate for their clients and their families, in the sense that it met their information needs. They also believed that it was easier to transmit the required information. However, 50 per cent of professionals found that the new approach sometimes required extra time for instruction, which lengthened the day surgery process overall.
On June 11, 2001, the Day Surgery Perioperative Program (Health Calendar) was implemented with individuals having gallbladder and hernia surgery. In the near future, we plan to use the program and its tools for all adult day surgery clients.
The self-care support research team includes France L. Marquis, France Chassé, Édouard Hendriks, Louise
G. Pelletier, and Noëlline Lebel.
For further information, please contact:
France L. Marquis, M.Sc.Inf.
Nursing--University of Moncton, Edmundston Campus
E-mail: fmarquis@cuslm.ca
Sharing Resources
Book Review
by Lynne Young RN, Ph.D,
University of Victoria School of Nursing
Negotiating Health Care: The Social Context of Chronic Illness by Sally Thorne, S. (1993).
Newbury Park, CA: Sage. (Soft and hard cover 263 pages).
Self-care is never more complex than when one lives with a chronic illness. Because chronicity entails regular interactions with the health care system and its practitioners, self-care in chronic illness is not only an individual pursuit, but also a practice shaped by interpersonal and system-level influences. Negotiating Health Care: The Social Context of Chronic Illness by Dr. Sally Thorne draws on the research to chronicle the complexity of the chronic illness experience. Thorne's text leaves readers with a vivid, and often moving, illustration of the lived experience of chronic illness, enmeshed in the complexities of an imperfect health care system.
This book is a must-read for professionals committed to supporting patients/clients self-care practices. Readers gain important insights into the individual experience of coming to live with a chronic condition, the process those living with a chronic illness go through as they develop working relationships with health care providers, and the system-level factors that shape both the individual experience of chronic illness and the heath care relations it engenders. Armed with this knowledge, health care providers can support the self-care practices of clients/patients living with a chronic illness, with empathy and wisdom.
Article review
by Lynnette Leeseberg-Stamler, Ph.D, BScN Program, Nipissing University
Dunn, K.S., and Horgas, A. L. (2000).
"The prevalence of prayer as a spiritual self-care modality in elders." Journal of Holistic Nursing, 18, 337-351.
This study sampled 50 individuals living in the community on their use of prayer and other spiritual treatment modalities as coping strategies. Ninety-six per cent of the sample used prayer as a coping strategy. More individuals from groups other than church groups reported using frequent use of prayer than did the individuals recruited from church groups. Men and Whites used prayer less frequently than did women and Blacks. Use of positive coping strategies was significantly correlated with the total spiritual treatment modalities used.
Although the sample was small, this research is valuable because it supports the importance of health professionals including spirituality as part of the health assessment. It also highlights the importance of discussing spiritual treatment modalities with our patients/clients, and ensuring that the person has time and resources to engage in positive spiritual practices within the care regime. The authors report previous research indicating prevalence of prayer increases with age, and that older people who used positive religious coping strategies had higher quality-of-life scores than those who used negative religious coping strategies. As we work with an increasingly older and more diverse population, the value of spirituality cannot be overlooked.
Website review
by Juliette (Archie) Cooper, Ph.D, BOT,
School of Medical Rehabilitation
University of Manitoba
 Help for Evaluating Web Content Related to Health Matters
The internet provides an ocean of information about health for consumers and health professionals. However, not all sites are informative or accurate. Sometimes it can be difficult to determine if the information presented is evidence-based.
The Health On the Net Foundation (HON), located at www.hon.ch, provides an evaluation tool for those who seek information as part of their self-care strategy. The Foundation, based in Switzerland, has as its mission "to guide lay persons or non-medical users and medical practitioners to useful and reliable online medical and health information." To do this, it has a code of conduct for website developers plus a set of criteria used to evaluate the accuracy of websites. Information is available in both English and French. Results from its search engine, Med Hunt, are presented in a format that includes not only the location of the site but also whether or not the site is commercial, the language of the site and key words. Other useful features of the site include surveys, illustrations and a wealth of links.
Want to Talk?
The Supporting Self-Care Discussion Mailing List provides you with the opportunity to share ideas with like-minded people who care about Supporting Self-Care and the kinds of things raised in this newsletter. If you are a member of the mailing list you can post a message now to [e-address was here]. If you are not a member of the mailing list, send a message to [e-address was here] and we will be pleased to add you to the list.
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