| Título: | Why won’t they do as they’re told? Collaborative decision making in client care |
| Autores: | Rees, M; Hunter New England Local Health District, NSW. |
| Fecha: | 2013-10-13 |
| Publicador: | Hunter New England Local Health District |
| Fuente: |
Ver documento |
| Tipo: |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
| Tema: | Nursing; Midwifery; Chronic Disease Management |
| Descripción: | Chronic disease is managed most effectively when a self–management approach is adopted by the individual, with advice and support from health professionals. While this approach was acknowledged and encouraged by the author, a community nurse (CN), poor client engagement resulted in sub optimal outcomes, including life threatening emergencies, for clients and frustration for the CN. This paper explores the CN’s practice within an isolated rural community, examining the successes and failures of client self-management. A review of best practice literature on chronic disease management, thematic analysis of client medical records and reflection of the CN practice within the context of client decision making factors, resulted in trialling of alternative strategies for client engagement by the CN. These strategies focused on the CN/client relationship, the clients’ physical and mental health, and the processing and sources of information used by the client. Using these strategies, active engagement and client responsibility for self-care with improved outcomes was achieved with 43.75 % of clients. The 56.25% of clients who were unsuccessful in self-managing their chronic illness were referred to a multidisciplinary team and case manager who provided regular review. The CN was able to identify significant geographical, health professional, health service and client factors as barriers to self-management for rural clients, and individualise plans for those unable to self-manage their condition while supporting those who lacked the confidence to do so. This necessitated integration with existing community groups, understanding of patient decision making factors and flexible practice within each community context and with each individual. It is only when clinicians remain cognisant of these factors that effective self-management of chronic disease can occur and patients, families and health professionals can be truly partners in care. |
| Idioma: | Inglés |