Patient Centred Care and Self Management Concepts & Theories Professor Marilynne N Kirshbaum Professor and Theme Leader of Nursing Charles Darwin University

In context of chronic illness Before diagnosis, in control of life and future After diagnosis – change Aim of self-management is to empower the person and enable them to maintain as much control over their life and future as they would like to have. Self- management requires a change in behaviour (health promotion and behaviour change strategies) Managing their life – not only their ‘condition’

Theory Role of theory: to make things that are hidden become visible (to provide the patterns that give meaning to observations, to provide explanations or predictions) Body of theory develops within a research community (discipline)

Concepts Power = an influence wielded by an individual or group to change behaviours, attitudes and to sway decisions. Implies dependency (wealth, information, prestige) Authority = a formal right, a legitimate power, usually by virtue of vertical position Empowerment = sharing of power, vision, knowledge, expertise, decision making

Concepts (2) Agency – people actively create or construct their social world and are motivated to control or to condition situations that affect their loves and maximise advantage Rationality – people are success oriented and motivated for immediate rewards, calculate costs and probabilities of receiving rewards or avoiding punishment. Structure - social and cultural influences that constrain and shape an individual’s behaviour and conscious experiences located in the unconscious mind, material relationships, myth and language, repetitive patterns in interactions

Self-care Deficit Nursing Theory Dorothea E Orem, USA Theory of self-care, self-care deficit, nursing systems

Patient-centered approach Faye G. Abdellah 1954-1992, USA, a Human Needs Theory for use in nursing education and practice Integration of how social problems, poverty, racism, pollution, education impact on health 21 nursing problems to identify client problems (physical comfort, prevent injury, nutrition, elimination, spiritual goals, therapeutic environment, fluid and electrolyte balance)

Social Exchange Theories Utilitarianism: ‘The greatest good for the greatest number’, from economic theory An attempt to explain human interactions in all social contexts, without limitations

Determinants of behavioural change Model of Self-Efficacy (Bandura 1997), Theory of Planned Behaviour (Ajzen & Madden 1986, Ajzen 1991), Stages of Change (Prochaska & DiClemente 1984) Beliefs Intention to change Social norms Motivation Decisional control Perceived behavioural control

Stages of Change (Prochaska & DiClemente 1984) (Dynamic) change occurs when the benefits outweigh the perceived problems of not changing (e.g. smoking) Decisional balance ‘tilts’ Insight into the decisional process is encouraged (i.e. involvement vs. pressure)

Theory of Planned Behaviour (TPB) Ajzen & Madden 1986, Ajzen 1991 What determines ‘behaviour’? Intention due to personal and social influences (Theory of Reasoned Action) ?motivation? What about ability or resources to act? TPB: attitudes, subjective norms and perceived behavioural control influence intentions behaviour. Perceived behaviour control also influences behaviour directly.

Empowerment is …an ethos that underpins care and management … a process through which people gain greater control over decisions and actions affecting their health (WHO 1998) …an ethos that underpins care and management …a philosophy that began as a result of communities or groups feeling oppressed or powerless

In context of chronic illness Before diagnosis, in control of life and future After diagnosis – change Aim of self-management is to empower the person and enable them to maintain as much control over their life and future as they would like to have. Self- management requires a change in behaviour (health promotion and behaviour change strategies) Managing their life – not only their ‘condition’