Self Management in Nursing

A Concept Analysis in Behavior Management: Self-Management in Psych Nursing Introduction In nursing, when it comes to behavior management—i.e., helping individuals to alter their behavior in order to achieve a positive aim—various strategies are available. One concept of behavior management that has been handed down over generations of nursing practice is the concept of self-management.

This concept analysis paper will analyze self-management by describing a history of the concept, its defining characteristics and attributes, antecedents and consequences, various cases related to the concept, empirical measurements, and recommendations following a discussion of the analysis.

Aims and Purposes of Analysis Aims The aims of this analysis are: 1) to obtain better understanding of a concept; 2) to obtain clarity in terms of what the concept means and how it impacts an environment, a population, a sector, an industry or a strategy; and 3) to establish definition in terms of empirical evidence that can be used to develop evidence-based practice, which is so crucial for the improvement of quality care in nursing overall (Northington, 2018).

Purpose The purpose of this analysis is to define the concept of behavioral self-management as it applies to psych nursing by: a. evaluating the history of the concept—how it was identified, developed, tested and revised b. defining its characteristics and attributes c. analyzing model, borderline, related and contrary cases d. obtaining empirical measurements e.

and discussing the research so as to give recommendations for practice Definition My definition of self-management as I understand it is that behavioral self-management is an empowering tool that appeals to the need of the patient to be more engaged with and actively participating in the patient’s own care process.

Self-management occurs when patients are active participants in the care process, when they oversee the care strategy designed and developed between them and their care provider so that the patient can manage their own care and be more engaged in the process, and when the implement the care design themselves in order to manage effectively their own behavior and bring it into conformity with the target goals of the behavior management process Using this definition will help to add to the nursing body of knowledge because it uses combines specific terms that integrate a number of theories to help support a concept of behavior self-management that be used in the psych nursing field.

These theories include Maslow’s (1943) theory of human motivation and the needs hierarchy that he developed to explain the progression of motivation by having lower level needs met first as the individual grows to a level of self-actualization. Other theories included in this definition that help to expand its meaning and give it new application are the theories of classical conditioning developed by Pavlov (1927) and Skinner (1953).

These two theories helped to lead the way to cognitive behavior theory, which was then developed into one of the leading psychoanalytic therapies today—cognitive behavioral therapy (CBT). CBT plays a part in behavior self-management in that the target behavior is identified by the patient with the assistance of the psych nurse and the patient is then given the tools and empowered to self-manage his or her own behavior in order to reach the target. Literature Review Databases Searched · PsycINFO · U.S.

National Library of Medicine’s MEDLINE, · Cochrane Database of Systematic Reviews · Cochrane Central Register of Controlled Trials · American Psychological Association’s PsycARTICLES · Sociology Research Database SocINDEX · Cumulative Index to Nursing and Allied Health Literature (CIHAHL) Keywords used to conduct the searches were “behavior self-management.” History of Concept How it was identified.

Creer was the first to use the term (Grady & Gough, 2014), which he applied to “indicate that the patient was an active participant in their care” (Lubkin & Larsen, 2013, p. 552). For Creer, self-management referred to the practice of giving the patient more say in terms of making decisions about how the care should proceed, the goals, and so on—much of which is currently used in the practice of cognitive behavioral therapy. How it was developed.

The concept was developed over time as care providers saw a need to include patients in the process of their own care. Patients have often demonstrated a need to feel more included in their own care process, and this concept developed as a result of providers realizing they needed to meet this need more effectively (Baird, Rehm, Hinds, Baggot, Davies, 2016; Al Danaf et al., 2017). As the concept was applied in diverse ways with diverse settings under diverse conditions, outcomes have been, predictably, diverse (Lubkin & Larsen, 2013). How it was tested.

The impact of self-management has been tested in various fields using both qualitative and quantitative analysis: for example, there have been studies conducted using multivariate statistical analysis (Verchota & Sawin, 2016), self-reporting (Schilling et al., 2009a, 2009b), experiment (Lorig et al., 1999), meta-analysis testing of participants (Chodosh et al., 2005) and interviews and surveys (Lorig, Sobel, Ritter, Laurent & Hobbs, 2001). Examples include: · Lorig et al. (1999) in which the researchers examined 952 patients in a randomized control trial.

The researchers’ intervention was a Chronic Disease Self-Management Program which took place over seven weeks, with sessions explaining how to self-manage so as to achieve self-identified goals rather than to achieve goals prescribed by a care giver. Measures consisted of health behavior, status and utility. Results showed that participants benefited by have fewer limitations six months after the intervention, less tiredness, and decreased anxiety about their health care. · Chodosh et al. (2005) attempted to measure the effect of self-management on patients suffering from hypertension.

The findings showed that it was unclear what exactly constituted self-management and therefore it was difficult to effectively measure whether self-management had any real impact on care, though among the participants blood pressure levels did drop. How it was revised. The concept was revised over the years and incorporated by various care providers into various disciplines so that it took on multiple meanings, vague meanings, looser definition, and overall ceased to possess a clear definition.

In short, self-management was a concept that applied to anytime a patient overtook the day to day operations of administering self-care for chronic conditions. Defining Characteristics or Attributes Characteristics The defining characteristics of behavior self-management are that the patient is in control of the process of assigning targeted goals and of overseeing the process of implementation. The patient is managing the process by assuming responsibility for the process and accountability—i.e., keeping accurate records of progression of the care process.

A degree of collaboration exists between the patient and the provider, but the primary decision maker in terms of setting goals is the patient. Attributes The defining attributes of behavior self-management are diverse and can range depending on the patient and the type of problem being addressed. Thus the attributes can include any of the following (Green, 2014): Proactive lifestyle. This includes any type of behaviors that the patient proactively engages in to support physical and mental health. Diet, exercise, recreation all fit into this attribute category.

So too does the patient’s demonstration of an ability to research the illness or health issue and discover more information that can be included into a proactive lifestyle plan to facilitate full recovery. Proactive problem-solving management. This includes any type of management practice designed to address a health problem suffered by the patient. Such practices would be taking medication, monitoring mood, blood pressure, etc. Proactive collaboration.

This type of attribute includes any sort of support person or group that the patients utilizes and who takes a vested interest in supplying support and even assuming a degree of responsibility for the patient. Activities include checking on the patient, providing expert advice if the support person is an expert on the area of need, and so on. Proactive mental support. This includes behaviors that the patient takes in order to facilitate the development of a healthy mental status.

The patient demonstrates awareness, ability to monitor self, ability to recognize and resist danger situations, the ability to plan and prepare and so on. Proactive planning. This attribute is defined by the ability to identify and pursue the goals of the intervention. Dynamic management. This attribute follows review of the process and includes revision of approach if necessary. Reactive management. This attribute facilitates the flexible management that the patient displays in response to changes in conditions.

Antecedents and Consequences Antecedents Patients must have the ability to exercise sound reasoning so as to be able to provide care for themselves. If patients cannot be trusted to monitor their own behavior, then they cannot partake in self-management. Other antecedents will depend on the type of attributes required for the behavior self-management process.

If patients intend to focus on proactive collaboration, for instance, they will need to have a support group, person or network in their lives that can provide assistance and expert opinion if needed on a daily or weekly basis. Consequences Consequences of behavior self-management are that the patient obtains a sense of empowerment, more autonomy in the care process, and feels included in the determination of goals and the pathways that are chosen to reach them.

The patient can always turn to experts for advice, but the main takeaway from behavior self-management intervention is that the patient is assuming proactive responsibility for his or her own care and is thus fully engaged instead of passively relying on the expertise and Model, Borderline, Related and Contrary Cases Model Case A 25-year old patient suffering from depression wants to take a proactive approach to managing his care. He is a graduate student at a local college, has a full-time job, and is in a relationship.

He demonstrates well the ability to reason, to respond to questions, and to assume responsibility. His desire for engagement and inclusion in the care management process appears rooted in his interest in being part of the solution and owning the process rather than being a passive observer in the process. The psych nurse informs the patient of the behavior self-management process and the patient responds that he would like to try that.

The patient identifies the goals he wants to achieve, the dangers he needs to avoid, the manner in which he will monitor his progress, and the methods he will use for addressing issues when they come up.

He identifies a collaborative partner that he would like to use during this process and the collaborative partner agrees to come in and meet with the psych nurse to go over what is involve in the behavior self-management process and that he would also have to assume responsibility for the patient’s progress by accepting the role. The collaborative partner agrees and the self-management process begins.

At six weeks, the patient returns asserting that his depression has lessened substantially and that he feels that he is doing very well with the self-management process. The collaborative partner agrees and asserts that the patient’s behavior has been much more positive over the past 4-5 weeks and that episodes of depression have not been as prolonged or as hurtful as in the past. Both are optimistic about the process going forward and agree to come in for another 6 week check-up.

At that check-up both state that depression issues have nearly all been resolved. Borderline Case The patient is 33-year old woman who wants to feel included the care giving process, but she is not willing or able to oversee the management process on her own and does not want to enlist the aid of a collaborative partner who will take a proactive process in the management process. At the same time she wants to be able to identify the goals of her treatment on her own.

She wants the physician to guide the process and provide her with the needed support; however, she is also willing to try to manage it on her own to some degree. She is not sure of what steps to take and she does not have the time to research information on her own. She likes the idea of assuming responsibility and engaging in self-management, but she is afraid she might not be able to make the right choices.

Related Case A 40-year old female patient who is an executive wants to manage her care more effectively and engages in independent research of her condition online to evaluate signs and symptoms that she is having. She takes them to the psych nurse for an expert opinion but ignores the recommendations of the physician and does not take a prescription because she feels she is able to identify alternative methods of treatment and is fully engaged in identifying solutions and goals on her own.

Contrary Case A 52-year old male patient in poor physical and mental health has no ability to make independent decisions on his own. The physician oversees the management of his mental health care completely by identifying the goals of behavior for the patient, prescribing medication for the patient, and monitoring the patient’s progress through an out-patient program at the clinic.

Empirical Measurements Knowledge Knowledge of the processes, steps, monitoring methods, and so on can all be measured empirically by taking a brief quiz that demonstrates to the psych nurse the extent to which the patient is capable of making logical and appropriate decisions. Ability Ability to engage in the behavior self-management process can be measured by taking a physical exam, a mental health exam, and a stress test exam.

Each of these exams would indicate the degree to which the patient is physically and mentally fit to engage in behavior self-management. Progress Once the process is implemented, the patient’s progress can be monitored by the physician upon check-ups at 6 week intervals. If the patient is not making progress as demonstrated by the self-monitoring accounts kept by the patient, the psych nurse can recommend a revision to the process or that self-management be traded over for a different management style.

Discussions, Recommendations and Conclusions Discussion In the model case it can be seen that the patient is proactive, willing and able to engage in the behavior self-management process. He even has access to a collaborative partner who is willing to assist in the process. This would be an example of proactive collaboration. In the borderline case the patient is only half-willing and half-able to engage in the behavior self-management process.

This has the potential to be a problematic approach to the process; at the same time, the patient could realize that she has the ability to take ownership of the self-management process.

The fact that it could go either way indicates that the psych nurse should provide more guidance and assistance up front before any time of independence or autonomy is fully granted to the patient in terms of her being on her own to oversee the process as it is clear that at this point it is not even what she desires. The related case shows that the patient is able and willing to engage in self-management after some consultation in which she obtains expert advice.

The patient is not even really willing to be a.