Supporting Self-management

• Activity Management/Pacing:

  • Aims:
  • increase meaningful activity
  • energy conservation
  • consistency
  • quota > symptoms contingent
  • pursuance of goals
  • Skills:
  • planning
  • prioritising
  • alternating activities
  • gradual increase over time
  • breaking tasks down
  • rest breaks
• Exercise or function?

  • exercise and movement are generally seen as helpful
  • no clear evidence that any exercise better than any other
  • why is the patient exercising
  • loading
  • progression and modification skills
• Potential challenges of exercise

  • pain
  • comparison
  • self-criticism
  • fear of judgement
  • physical sensation of exertion
• Overcoming potential challenges of exercise:

  • find a place they can start
  • resist ruling out activities
  • support the early stages
  • reinforce ability to self-manage early on
  • skills
  • link exercise to what matter
• • Value linked goals to provide motivation to get over the fear avoidance model

  
• Exposure:

  • is it challenging?
  • why is it challenging?
  • what can the patient do?
  • how can intensity/context be varied?
  • how can the patient start to practice independently?
  • important to review - can be self-review
• • Need to develop the tasks and then review the tasks
  • why is it important?
  • what did you notice as you did the task?
  • if you could do more of this, what would that mean for you?
  • what could you do next?
• Desensitisation:

  • process of using sensory input to create ability to manage challenging sensory inputs
  • can be pressure/temperature/texture/water or air movement
  • types of input
  • relevance - functional or real tasks
  • attention to task is important
  • different contexts
• Communication:

  • identifying challenges
  • communication styles
  • skills practice
  • compromise - or not
  • communication with healthcare professionals
  • self-reflection
  • assertive communication
  • role-play
  • videoed role-play
  • communications ABC's
• Setback plans:

  • individual
  • may involve rest
  • selfcare - may be challenging for the patient
  • support network
  • reminders that flare-ups dont last forever
  • plan to get back to things
• Discharge:

  • abandonment
  • agreement
  • no surprises
  • reinforce patients capabilities
  • setback plans
• Challenges:

  • patients will experience more pain
  • ensuring level of challenge
  • developing and maintaining therapeutic relationship
  • time
  • what ifs
  • holding distress
• Person Centred approaches:

  • empowering people in their lives and communities to enable to an upgrade in prevention, wellbeing, health, care and support
  • via:
  • conversations to engage with people
  • conversations to enable and support people
  • conversations with people to collaboratively manage highest complexity and significant risk