SELF-MANAGEMENT: AN OVERVIEW
Self-management prepares patients and their families to take an active role in their health care. In the traditional medical model, the patient has symptoms and goes to the doctor for treatment. The doctor is the one who knows what to do and controls the treatment and outcome. This model works well for acute problems such as a broken leg or heart attack or in the early days following injury. As recovery progresses or medical conditions require long term solutions, the person has a much bigger role to play.
Self-management changes the way we think about our health. While the doctor and other health care professionals can help, we now recognize that so much of our health depends on us and what we do. This means we all need to learn to care for ourselves. To do this we need to learn how to help ourselves and help the doctor help us.
Taking an active role in your health care leads to better health outcomes. In self-management, people are empowered to learn about their conditions and treatment options, and they learn to take on more responsibility for their own health. Self-management involves increasing knowledge, problem-solving, using resources, monitoring one’s condition (self-monitoring), and applying skills and knowledge (such as progressive relaxation for pain or anxiety, communication skills,), among others.
While we recognize more is being asked of patients and their families, most are not formally trained for this important task. Self-management programs such as NextSteps, part of the TSN, are about learning more about our health, how to work better with the doctor and help ourselves. Self-management helps solve problems and improve health outcomes. You can learn more about NextSteps in here (PROVIDE LINK). NextSteps for trauma survivors helps people become good self-managers. The goal is to build their confidence and skills to better manage problems such as pain, anxiety and depression, and it helps them have better relationships with family, friends and doctors by improving their communication skills.
SELF-MANAGEMENT: HOW IT WORKS
Self-management programs have been developed for many illnesses and conditions and have been shown to improve health and quality of life. They are based on cognitive-behavioral theory and principles. Cognitive-behavioral theory is based on the scientific finding that how we think about a situation determines our emotions and our behavior. For instance, we may get angry about being stuck in traffic because we know we’ll be late for an appointment. One person may choose to spend the next 30 minutes fuming. Another may try to get through the mess faster by angrily changing lanes often. Cognitive behavioral therapy suggests a more adaptive approach, such as saying, “Oh no, a traffic jam! Well, there’s nothing I can do to change this. I’ll call ahead and let Joe know I’ll be late. Then I might as well put on some music and relax. This is a perfect time to get out my new CD.” Self-management uses active, structured techniques to improve cognitive, emotional and behavioral responses. The focus is on skill-building, with special emphasis on problem-solving skills. Self-management research on conditions such as arthritis, fibromyalgia and diabetes has shown that cognitive behavioral programs have improved pain ratings, distress, psychological status and daily functioning. Increased self-efficacy seems to account for much of the improvement. Self-management promotes self-efficacy via skills training, and these improvements last over time. Also, self-management can reduce use of medical services over the long term.
SELF- MANAGEMENT: PREPARES PATIENTS AND FAMILY FOR THE WORK OF RECOVERY WORKERS
Following trauma and injury, patients and their families are placed in a new situation and are faced with many new tasks. This “work” is on top of the ongoing responsibilities we all have in our daily lives.
Patients and their families have many things to do: finding health care providers, researching treatment options, keeping appointments, following treatment regimens, filing insurance claims, dealing with managed care, arranging transportation. There is also the work of coping with the trauma, learning what you can still do and how you have changed. All this is on top of the extra time it takes to do self-care activities, develop work/school options, try to maintain life the way it was before the injury, and sometimes try to hide how things have changed.
Most of this work is invisible to those outside the family. Society, employers and health care providers often do not recognize how much work is being asked of patients and their families and are not supportive. In addition to not being acknowledged for all they need to do, patients are not trained to do these activities.
Self-management programs address these challenges. These programs:
- recognize, acknowledge and appreciate the work that patients and their families do
- help them realize that they are the central workers, the folks who determine how their recovery will go
- provide the skills they need to do this important work
SELF-MANAGEMENT: THE KEY PRINCIPLES
- Shifts the power to patients and families; instead of relying on doctors alone to “fix” you, you learn to help ourselves
- Teaches the problem-solving method
- Helps expand support and resources
- Teaches skills to track your health and progress with goals
- Provides health education and mental health education
- Works to bolster self-confidence
- Helps you actively take part in our health care
- Teaches skills, such as communication and relaxation, to improve how you feel and your quality of life
- Teaches you to pay attention to your self-talk and encourages positive self-talk
SELF-MANAGEMENT: THE BENEFITS
- More personal power. You become skilled at finding solutions to your health problems. You learn to take control of situations that may have felt out of your control in the past.
- Increased confidence.As you experience successes with self-management, you have greater confidence in your abilities.
- Self-management skills prepare you to handle difficult situations. By being prepared, you’re better able to handle difficulties as they arise, rather than experiencing a crisis. You can turn what used to be a “wall” into a speed bump that you can deal with.
- Improved health. If you set health goals and follow a plan for achieving them, you begin to notice improved health.
- Better quality of life. Having better health and having confidence in yourself, you’re able to enjoy your life more.
Learn More If you want to learn more about self-management check out the following material:
Holman, H.R. & Lorig, K.R. Patient self-management: A key to effectiveness and efficiency in care of chronic disease. Public Health Report, 2004, 119 (3), 239- 243. http://www.ncbi.nlm.nih.gov/pubmed/15158102
Lorig, KR. & Holman , H.R. Self-Management Education: History, Definition, Outcomes, and Mecha..." Annals of Behavioral Medicine . 2003, 26 (1) 1-8. http://www.ncbi.nlm.nih.gov/pubmed/12867348
Wiener, C. Untrained, unpaid and unacknowledged: The patient as worker. Arthritis Care and Research, 1989, 2 (1)16-21 http://www.ncbi.nlm.nih.gov/pubmed/2488117