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

2. 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’

3. 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)

4. 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

5. 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

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

7. Patient-centered approach
Faye G. Abdellah , 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)

8. 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

9. 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

10. 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)

11. 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.

12. 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

13. 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’