Self-Care and Contracting

HAS 3190

Self-Care

• Wives tales, herbs, potions• Families• Technology• Insurance• Self-care not 1st choice

Today’s Factors

• Consumer movement – want quality, 2nd opinions

• Women’s health movement – birth control• Inadequacy of present system – for poor and

uninsured, nosocomial infections• Economics – high cost of health care• Chronic disease – 80% of patients, many

diabetics in long term care facilities• Accessibility and visibility – consumer health

libraries/internet

Self-care vs Formal care

• What do they have in common?• Where does the control lie?• Barriers?• Role of health educator?

Provider taught skills…

Physical therapy examples

Home care

• Teaching – ie. ADLs, meds, dressing changes

• Methods – ie.return demo, verbalize understanding

• Examples – ie. pillbox, keeping medical record

Self-help groups

• Lay people• Common experiences• Confidence and self-respect• Ability and willingness

Self-care workshops

• Partnerships• Provide opportunities…• Topics…

Self-management methods

• Self-monitoring• Self-evaluation• Self-reinforcement (rewards)

Deterrents

• Dependency on professionals• Afraid• No rewards• Lacking skills• Rewarded inappropriately

Barriers to self-care

• Consumer problems• Programmatic problems• Institutional problems

Change

• Awareness• Active interest, info gathering• Mental trial (intellectual insight)• Trial (practice)• New learned behavior

– Unfreezing– Change– refreezing

Negotiation

• Agreement and disagreement• Patients better off

Models of negotiation

• Activity - passivity• Guidance – cooperation• Mutual participation

Shared responsibility

• Patient’s responsibility is central theme

• Health pro identifies problems

• Can patient follow directions?

• Can patient incorporate into daily life?

Weighing Options

• Scenario… (stress mgmt)• Cost• Convenience• Individualism

Balance Sheet

• Tangible gains and losses (for self or for someone else)

• Approval or disapproval (of self or by others)

Balance Sheet

Report Card

• Grade options (A, B, C)• Review sum totals

Report Card

Practicality-Probability

• Possible, probable, practical• Cross out options• Look for practical

Practicality - Probability

Rank Ordering

• Rank options• Client reviews rank options

Rank Ordering

Valued versus Utility

• Assess value and utility

Value and Utility

Imagined Conversation

• Imaginary conversation with someone who has a different viewpoint.

• Keep track of arguments

Negotiation fails…

• Coercion• Focus on areas of compliance• Ignore the problem

Patient Contracting

• Formal versus informal• Specifies particulars• Connect to behavioral theories• Increases patient skills

Mutually agreed upon…

• Clear, specific, measurable goals

• Clear behaviors (who, what, when, where)

• Reinforcements

• If behaviors not performed

• Performed beyond expectation

• Dates (start, renewal, modification, end)

Written Contract

Self Contract