5A s Model for Self Management

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Transcription:

5A s Model for Self Management

5A s Model for Self Management The Five A s is a counseling approach that entails a series of sequential steps to facilitate patient selfmanagement and behavior change (World Health Organization 2004). Each component is utilized in a face to face patient encounter. Assess Advise Agree Assist Arrange

5 A s Model: Assess Have patient periodically complete valid health behavior surveys and provide them with feedback. Try brief behavior survey in a) waiting room, b) on computer. Assess patient knowledge about their chronic condition. Ask patient, what about self management is most important to talk about today? Ask patient: what are your most challenging barriers? Recognize physical, social and economic barriers. Provide patient with personalized feedback and results. Assess conviction and confidence regarding target behaviors.

5 A s Model: Advise Provide personally relevant, specific recommendations for behavior change. During dialysis, relate patient symptoms or lab results to their behavior, recognizing patient s culture or personal illness model. Inform patient that behavioral issues are as important as taking medications. Provide specific, documented behavior change advice in the form of a prescription. Share evidence based guidelines with patients to encourage their participation.

5 A s Model: Agree Use shared decision making strategies that include collaborative goal setting. Have patient develop specific, measurable, feasible selfmanagement goal for behavior change. Provide options and choices among possible selfmanagement goals. Utilize input from family or spouse, and with support/assistance from caregiver. Share perspectives with patient on what is most important short term goal and agree on a specific target. Present evidence on benefits and harms to patient and let them decide on course.

5 A s Model: Assist Use effective self management support strategies that include action planning and problem solving. Help patients create specific strategies to address issues of concern to them. Help patient develop strategies to address barriers to change (write on Action Plan form). Implement patient discussion of self management action plan a) during dialysis treatment, b) immediately before or after with nurse, c) during physician office visit. Refer patient to evidence based education or behavioral counseling individual or group.

5 A s Model: Assist (cont.) Elicit patient s views and plans regarding potential resources and support within family and community. Use planned interactions to support evidence based care. Give care that patients understand and that fits with their cultural background. During follow up visits, review progress, experience, concerns; renegotiate goals and revise action plan.

5 A s Model: Arrange Follow up on action plans. Follow up on referrals. Establish two way communication and partner with community groups to improve services and linkages. Give patient copy of SM Action Plan. Follow up call to patient within a week after visit as booster shot for SM Action Plan. Email follow up or brief letter restating plan and inviting questions. Arrange for patient to contact specific community resources that could support their goals. Follow up with goals set in action plan at each non acute visit.

For additional information, please visit the 5 Diamond Patient Safety Program website at http://www.5diamondpatientsafety.org. The 5 Diamond Patient Safety Program is endorsed by the Renal Physicians Association (RPA), National Renal Administrators Association (NRAA), American Nephrology Nurses Association (ANNA), and American Association of Kidney Patients (AAKP). Module Revised May 2014

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