Supporting Self Care Network
Newsletter
October 29, 2001, #2
Supporting Self Care and Empowerment...
Contents
Welcome
Editorial
Highlights
Member Profiles
In Practice
Sharing Resources
Welcome
by Robert Shearer, A/Director of the Health Human Resource Strategies Division Health Canada
It is with great pleasure that I was given the opportunity to welcome you to the second newsletter of the Supporting Self-Care Network. I found the articles very stimulating, particularly these written by the new Network members. This issue highlights a current and interesting topic: power/empowerment. The authors cover topics such as the complexity of the empowerment concept and the difficulty in defining the concept. The editorial introduces us to this discussion by summarizing a one-day conference that took place last June in Montreal (Quebec). We are interested in your feedback and any questions you may have about the Supporting Self-Care Network. I invite you to turn on your computer and to use the Discussion Mailing List to initiate conversations around this topic or to react to the articles. To do so, email your message to [e-address was here]. Should you have any questions, comments or suggestions on this newsletter, please contact Isabelle Caron, network coordinator, at [e-address was here]. If you wish to write a letter, and support Post Canada, it can be mailed to: Isabelle Caron Jeanne-Mance Building, Room 1700D, PL 1917D, Tunney's Pasture Ottawa, ON K1A 0K9 We are also looking for ideas and authors for future issues. Bonne lecture!
Editorial
Support for Self-Care: The Acknowledgement of Power
by Denise St-Cyr Tribble, RN, Ph.D. Research Professor (Associate) Department of Nursing Université de Sherbrooke Scientific Director, CLSC de La Région-Sherbrookoise (CAU)
Dominique Tremblay, RN, M.Sc. Acting Director of Nursing Hôpital Charles LeMoyne, Greenfield Park
Frances Gallagher, RN, M.Sc., Ph.D.
Lecturer, Department of Nursing, Université de Sherbrooke
Researcher, CLSC de La Région-Sherbrookoise
Support for self-care, regardless of the age of the individuals concerned, means accepting that people can exercise greater control over their health and well-being. Health and social services researchers and workers have a complementary responsibility to build on the strengths of the individuals using their services. Out of respect for their clients, they must help clients improve their lifestyle and develop methods of facilitating individuals' use of self-care and improve their self-care abilities, in the areas of care itself, health promotion and disease prevention. This vision requires professionals to work in partnership with families, and shows the urgency of establishing a transparent dialogue as soon as initial contact is made with clients. Such openness is demonstrated by the acknowledgement of the other's power and the sharing of power within the intervention.
The concept of empowerment is often used to describe interventions designed to enable self-management of health; the concept of appropriation is used to describe the outcome. Despite discussions, there is no consensus in the literature (St-Cyr Tribble, Gallagher, Paul, Archambault, 2001) nor among stakeholders (decision-makers, researchers and teachers) about the definition of empowerment. Self-management of health has been declared to be important, but we know little about the interventions that promote it and still less about the reactions of the client groups that practise it.
Accordingly, a scientific meeting was organized in June by the Nursing Branch, Hôpital Charles LeMoyne, and the Department of Nursing, Université de Sherbrooke, to identify some of the issues surrounding the power of professionals in relation to their clients' health. The session, entitled "Exploring Power: A Health Odyssey," was designed to provoke thought, stimulate discussion, cause participants to question their beliefs, and support them in their thinking about power.
The papers, workshops and panel facilitated the exploration of a range of factors that come into play in the issue of power. Professional values, the type of socialization to which we are exposed (both professionals and clients), beliefs, personal experiences, the definition of the patient's role, the importance placed on control and expertise, organizational structure, and the contribution of the patient's experience to an intervention that is intended to be carried out in partnership are all factors that influence intervention models. The majority of participants believed that recognizing clients' ability to make appropriate health choices required us to reframe the way we see interventions. Such reframing should have a positive effect on the health of clients, including those who are facing complex situations.
The meeting created momentum that is now an integral part of the things that need to occur in the pursuit of activities related to supporting self-care. It is crucial that professionals be made aware of how they exercise their power
if clients are to be given the opportunity to use or develop their own (Michaud and Tremblay, 2001).
References
St-Cyr Tribble, D., Gallagher, F., Paul, D., Archambault, A. (2001)., L'habilitation des parents: étude qualitative de l'intervention infirmière et psychosociale. Actes du VIIIe Congrès international de formation et de recherche en éducation familiale (AIFREF), p. 128.
Michaud, C., Tremblay, D. (2001). La notion de pouvoir dans une organisation. Paper presented at the scientific meeting "À la découverte du pouvoir: une odyssée de la santé", organized by the Hôpital Charles LeMoyne and the Department of Nursing, Université de Sherbrooke.
Highlights
Follow-up to the June 2001 Symposium
by Lynnette Leeseberg Stamler, Ph.D.,RN, BscN and Alain Pavilanis, MD, CM, CCFP, FCFP
Co-chairs of the Supporting Self-Care Initiative Coordinating Committee.
On August 17, 2001, the Supporting Self-Care Initiative Committee had its last face-to-face meeting and developed an action plan for the future. This includes two main activities:
- Through the Canadian Nurses Association, the committee will publish and disseminate the Symposium report, as part of a larger report containing appendices describing the results of the various projects and activities carried out by the four partners (Canadian Nurses' Association, College of Family Physicians of Canada, Association of Canadian Medical Colleges, Canadian Association of University Schools of Nursing) and Health Canada during the past two years. This document will summarize the activities and conclusions of the supporting Self-Care Initiative to date. It is expected that this report will be completed by the end of this year, and will be available for distribution in both official languages at the beginning of 2002.
- The second task will be the main challenge. A new university-based multidisciplinary working group will develop a proposal for a collective national project to focus on primary health care reform. A proposal to Health Canada for funding of a national project in primary care reform that integrates the concepts of Supporting Self-Care will hopefully be funded. The four partners have agreed to contact various educational institutions who have already participated in the Supporting Self-Care strategy in order to form this new multidisciplinary working group.
A request for an extension of the Supporting Self-Care Initiative has been submitted by CNA, on behalf of the four partners, to Health Canada, for the period September 20, 2001-March 2002 with additional funding. The possibility of launching a national program based on the best thinking and experience of the past few years is very exciting!
Member Profiles
Juliette E. Cooper, PhD, OT (C)
"Helping people help themselves" is a key reason why Juliette "Archie" Cooper chose to become an occupational therapist (OT). Juliette, who is a Professor and Director at the School of Medical Rehabilitation at the University of Manitoba, believes that an OT's role is to work in partnership with people to help them define their goals and determine strategies to achieve these goals. "When you are successful", says Juliette "the client thinks they have done it by themselves".
"People often feel helpless in the medical system," says Juliette "and empowering people in this situation is an unbelievably powerful concept. Some people are reluctant at first, but they must be encouraged to be a leader in their care team. For example, occupational therapists can help patients make decisions about their care by preparing them for a difficult interview with their physician or care team. Role playing is an effective way to build confidence."
As an educator of health professionals, Juliette strives to promote the concepts of empowerment and client-centred practice. These ideas are sometimes difficult to get across. "Most students immediately think that helping means "doing for" the person instead of "doing with" them. Getting students to switch to a facilitator or coaching role takes a while. Sometimes they are unsure about their ability to take on this kind of role. Often, they face barriers to following through in practice. This is especially true in acute care facilities where there is little time to have a genuine conversation with patients.
"Supporting self-care means listening to clients, no matter what their age," says Juliette. "When dealing with a child who has multiple disabilities, we need to work with the child, her parents and her teacher-not to impose strategies on that child and her family-but to suggest options and find out what works best for them. Solutions have to fit with the child and family's lifestyle, as well as their economic, cultural and social situation."
As a member of the Supporting Self-Care Network Development Committee, Juliette is happy to speak with others who share the challenges of supporting self-care in education and practice. You can communicate with her through the Discussion Mailing List at [e-address was here] or by email at jcooper@ms.umanitoba.ca.
In Practice
Self-Care Initiative Following Hospitalization for Heart Disease: The Clients' Perspective
by Nicole Bolduc, RN, PhD, Assistant Professor, Department of Nursing
Faculty of Medicine, University of Sherbrooke
Marianne Xhignesse, M.D., M.Sc., Assistant Professeur, Departement of Family Medicine, Faculty of Medicine, University of Sherbrooke
Health care reform in Quebec puts the patient front and centre and proposes that the organization of services prioritize programming by client group. In the Eastern Townships, a regional integrated cardiac care program is being set up. One of the goals is to promote self-management of health in persons with heart disease. Focus groups were set up to find out what the experiences were of these individuals after they returned home, their needs, the difficulties they encountered and their self-care activities. The focus groups were made up of persons hospitalized for heart disease over the three previous months (n: 20) and their partners (n: 11). The narrative dialogue approach was used with six groups of individuals (three groups with heart disease and three groups of partners) in three regional county municipalities (rural, semi-rural and urban). The transcript of the audio tapes was analyzed according to predetermined categories.
The results show that, following hospitalization, the physical needs of persons with heart disease are generally met. However, for both groups, psychological needs remain an issue, regardless of place of residence. The main needs were identified as follows: to understand the disease and its treatment; to learn to deal with the demands of the disease; and to learn to manage anxiety and stress. Most said that their fears were partially eased through belief in a higher power. Their partners seem to see the benefits of self-care more than do the persons with heart disease, and they therefore tend behave in a controlling fashion with the patient with respect to diet, activities, etc. These differences in perception cause tensions in the home.
The results suggest that self-care is a process that evolves and improves through practice. Making decisions by oneself and taking practical action to deal with and improve one's own health requires not just know-how, but an initial attitude of psychological openness.
Sharing Resources
Book Review
by Laurie Potovsky-Beachell
Simple Meditation and Relaxation
by Joel Levey and Michelle Levey, Conari Press (1999)
ISBN: 1-57324-151-2, Hard cover, 306 pages
also published under the title Wisdom at Work
Finding balance in our everyday lives is essential to self-care. But this is more easily said than done. In days full of deadlines and technologies, methods of stress relief are often so complicated and time consuming that they cannot be fitted into our busy schedules.
For all of us whose lives are filled with multitasking, this book is great news. It is more than a good "how to" tool. It provides clear, simple instructions on meditation techniques, as well as interesting explanations of how to apply specific types of meditation to your personal lifestyle. There are exercises to help you develop concentration, mindfulness, and reflective, creative and heart-centered meditation skills. As important as this information is, what is most helpful are the suggestions for
incorporating short moments of meditation into our daily routines. Mindfulness breathing techniques become short periods of relaxation and help refocus our energies. Simple elements such as these can be incorporated into all of our daily lives.
Supporting self-care and self-care are intertwining concepts. Health practitioners themselves need to experience the benefits of meditation in order to acknowledge its value and be able to recommend it with authority. With this book as a guide, this becomes an easy thing to do.
Article Review
by Wayne Weston MD, CCFP, FCFP, Family Medicine, University of Western Ontario
Gupta K, Hooton TM, Roberts PL, Stamm WE. "Patient-Initiated Treatment of Uncomplicated Recurrent Urinary Tract Infections in Young Women". Annals of Internal Medicine. 201;135(1):9-16.
This is a study involving primarily young white university students with recurrent urinary tract infections (UTI) and low risk of STDs, who were attending a university-based primary care clinic. Ninety-four percent of individuals who initiated a three-day therapy with a fluoroquinolone had suspect infection (culture-proven infection in 84% and sterile pyuria in 11%) and self-treated appropriately. Clinical cure was observed in 92% of cases. Twenty percent reported minor side effects that did not require stopping therapy. A dramatic 99% felt comfortable with the process of self-diagnosis and would recommend the approach to a friend with a similar problem. Most patients felt that the duration of symptoms was less and that they were able to resume normal activity sooner with self-initiated therapy than they had previously with physician-initiated therapy. The authors conclude that well-educated women can accurately self-diagnose and self-treat recurrent UTI appropriately.
An editorial in the same issue by Andrew Herxheimer points out that "Every encounter between a patient and a physician is a learning experience for both, although the participants are rarely conscious of it." He recommends that we offer patients "learning packages" tailored to their desire for involvement in their own care.
We usually teach patients to look after their diabetes and asthma and could extend this approach to other conditions such as gout, sickle cell disease, severe herpes simplex, migraine and cardiac arrhythmia. By failing to ask patients about their own experiences with illness, health care professionals miss out on a great deal of valuable learning. To address this deficiency, an electronic database of Individual Patients' Experience (DIPex) is being established in the United Kingdom at http://www.dipex.org/ . It includes video and audio clips of patients' talking about their illnesses and treatments. Currently only hypertension and prostate cancer are listed.
Website Review
by Juliette (Archie) Cooper, PhD, BOT, School of Medical Rehabilitation, University of Manitoba
 Health Information for the whole family from the American Academy of Family Physicians
This website provides physician-generated information on a wide spectrum of specific health topics (e.g., abdominal pain, arthritis, diabetes, drug reactions, hip problems, osteoporosis, stroke). You can search for information by condition, age group, body part or topic. Self-Care is included along with Drug Information and Alternative Remedies. The content is informative, practical, easy-to-read and is updated frequently. The self-care section has a simple algorithm to help readers determine what to do when they have a particular problem or symptom. Topics at this site also include caregiver stress, end-of-life care, grieving, hospice care and spirituality. Because it is an American website, information is presented in English and Spanish. Some of the information may not be relevant to Canadian health care; however, on balance this could be a very useful site for empowering self-care behaviours.
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