Backwards Planning & Test Tubes Brian Akers Kat Royer 8/5/2015
Objectives Define backwards planning Review backwards planning cards & board Explain significance of test tubes
Student Hotspotting Resource Library Kick-Off Patient Trauma Harm Conference Selection & Informed Backwards Test tubes Reduction Enrollment Care Planning
Backwards planning is a tool to highlight patient priorities and to help create a collaborative care plan
Health Maintenance & Management Medication & Medical Supplies Medication & Medical Supplies Provider Relationships Benefits & Entitlements Legal Have medical Transportation Education & equipment & Employment medication Advocacy & Activism Housing & Environment Learn more Identification about Have a better relationship with my doctors & nurses See if I qualify for insurance or other programs Food & Nutrition Family, Personal, & Peer Better Addiction manage my pain Find Mental medications Health that work for me Feel at ease in my providers office Figure out if I qualify for additional income
NEED TO WORK ON RIGHT NOW Crisis Top priority Deadline LATER Opportunity for open-ended questions DON T NEED TO WORK ON Opportunity for open-ended questions Opportunity to highlight strengths
Discussion Questions What would you say to introduce this tool to a patient? What are some next steps that you would take after the board is completed?
Connecting task with vision
I want to be able to travel to see my sister so I can reconnect with her. I want to be able to live a normal life and go out and do things. By meeting someone where they are at and understanding their vision for their life, we can start to take them from where they are to where they want to be. I want to be able to go outside and play with my grandkids. I want to be able to go to family parties. I want to go back to school and get a job as a counselor so I can work with people.
Themes of what someone wants Significance Love & Belonging Certainty & Safety
Significance: The deep desire to feel important & recognized
Love & Belonging: The deep desire to feel accepted & cared for
Certainty & Safety: The deep desire to know what s coming next and to have controlled surroundings
Test Tube-Scenario 1 Carmen is very familiar to the team. You have known her for over one year. Carmen tells has had a host of medical issues for two decades now, and she is very fixated on the fact that no one has been able to tell her what s wrong with her. She has revealed much of her life to you, because of the long connection. Her entire family is back in Puerto Rico. She has a boyfriend, but he has never attended an appointment the entire time you ve known Carmen. You have followed up with multiple specialists, and you ve been impressed by how organized she s kept her medical records over twenty years. She is consistently fixated on what to do about her lab values, and even after one year of coaching, she still calls you for advice about what to do next.
Test Tube Scenario-2 You meet with Joe, a patient in his 60s. He continues to be readmitted because of high blood sugar. When you visit with him, he often reminisces about his power lifting days. He talks to you about how he won many lifting competitions, and he loved the feeling of winning. He still has the medals he won hanging in the living room. One of Joe s goals is to obtain diabetic footwear to prevent further wounds, and to prevent irritation of his existing wounds. You have a script from Joe s podiatrist and have medical supply store in mind where Joe can get his shoe fitted, but Joe really resists going. He complains of the price ($150) and says they make him look old.
Test Tube Scenario 3 Margarite is a patient you have worked with for 2 months now. She lives in a house with three children, but they each have their own families and commitments. They provide Margarite with the basics, like food, water, and bring up her medications each morning. Each time you go to the house, she is waiting downstairs for you, and often keeps you there for extended time reliving childhood memories. In the past month, she has gone to the ED twice complaining of intense knee pain. In the ED, she is treated for pain and told to follow up with her PCP. At a PCP visit, her physician tells her that the pain is most likely related to stress from bearing excessive weight. You came up with a nutrition/exercise goal with Margarite of walking down her block back and forth, and only drinking diet soda. At your next home visit, Margarite admits to not having walked in the last week and she is still drinking regular soda.
Test Tube Scenario 4 You recently met James who is 41 years old with a Driving Diagnosis of Acute Kidney Injury, secondary to chronic hypertension. He has lack of trust in healthcare professionals, limited income, and untreated mental illness and a lack of family support. Mr. English often stated that "the nurses and doctors try to avoid me because I am too loud and outspoken." He stated that the nurses at dialysis would say "Oh Lord here he comes." He stated "they act like they are busy so they don't have to talk to me." He believed he had another personality, which he referred to as "Bill." Mr. English did not have a mental health provider. Although James had chronic hypertension, he had no PCP to manage it. He was forced to rely on staff, that he didn't trust, at the dialysis center to manage his medications. He was left to deal with his mental health issues on his own. Mr. English resorted to street drugs, such as marijuana and cocaine to minimize the symptoms of his bipolar and personality disorders.
Utilizing Community Resources
Post-Webinar Team Assignment 1. Input your area s zipcode into Aunt Bertha website (https://www.auntbertha.com/) 2. Research available community resources 3. Brainstorm about which resources could potentially fulfill aspects of significance, certainty & safety, and love & belonging (Brian will send template) 4. Call/visit resources & start to build relationships!
Themes of what someone wants Significance Love & Belonging Certainty & Safety
Test Tubes are dynamic and apply to all of us Love & Belonging Level Certainty & Safety Significance Time
Explosions can occur Patient Care Team Member Frustration Hurt Anxious Not feeling recognized
Empathy = Vulnerability
Empathy = Vulnerability To build a therapeutic relationship and show true empathy in a situation, we have to remember a time when we felt similar emotions. This requires vulnerability. Based on what s happened in the past or what s currently going on in our lives, experiencing this vulnerability may be emotionally triggering.
Recognizing Vulnerability
Gladys Story What surface level reaction does Gladys speak to? What are the underlying factors that Gladys speaks to that are driving the surface level reaction?
Strategies for Individual & Team Self-Care What can you say to a team member, if you notice that they are emotionally triggered? How can you facilitate a conversation around empathy on a regular basis with your team? If you recognize (in the moment), that you are emotionally triggered what is something you can do or say to yourself? What are individual & team self-care strategies you can utilize outside of daily work?
Thank you! Questions?