pengurusan sesi pendidikan kesihatan

Modul Latihan Pegendalian NCD Untuk Paramedik KKM 1

PENGURUSAN SESI PENDIDIKAN KESIHATAN

ANJURAN :

BAHAGIAN KAWALAN PENYAKIT

BAHAGIAN PEMBANGUNAN KESIHATAN KELUARGA

Pendidikan kesihatan adalah proses perubahan perilaku yang:

• Dinamik di mana perubahan tersebut bukan sekadar proses transfer teori dari seseorang ke orang lain tetapi perubahan tersebut terjadi kerana adanya kesedaran dari dalam diri individu, kelompok, atau masyarakat sendiri

( Wafid Iqbal Mubarak & Nurul C,2009: 9-10)

2 Modul Latihan Pegendalian NCD Untuk Paramedik

Pendidikan kesihatan adalah usaha untuk menimbulkan

perubahan tingkah laku hidup sihat, baik lingkungan

masyarakat dan sosial.

Objektif:

•Komponen yang penting dalam memberikan perkhidmatan kesihatan yang komprehensif

•Membantu pesakit untuk mencapai tahap kawalan penyakit yang baik

•Membantu menggalakkan pesakit mematuhi perawatan sendiri seperti diet, senaman dan intervensi lain

Juga dikenali sebagai ‘Behavioral Modification’

Definisi Pendidikan kesihatan mengenai penyakit tidak berjangkit (NCD) yang diberikan kepada pesakit (& keluarga) yang merangkumi pelbagai disiplin Anggota kesihatan yang terlibat:

•Perubatan •Doktor •Diabetic Educator/paramedic •Pegawai Pemakanan •Pegawai Farmasi • Instruktor kecergasan •Kaunselor

4 Modul Latihan Pegendalian NCD Untuk Paramedik

Self management Education (SME)

Modul Latihan Pegendalian NCD Untuk Paramedik 5

•Adalah satu proses : •Kollaborasi • Interaktif •Berkembang •Melibatkan pesakit (& keluarga) serta Pendidik •Mengajar pesakit supaya boleh mengendalikan

penyakit kronik mereka sendiri dengan baik

Hogue V, et al. Diabetes Spectrum 2003

Change in clinical data, QOL Scores, & diabetes knowledge

Pre- to Post-Program Change in Clinical Data, QOL Scores, and Diabetes

Knowledge (All sites)

A1C

FBS

LDL

HDL

TG

TC

DBPSBP

PQSMQS

KS

-35

-30

-25

-20

-15

-10

-5

0

5A1C

Fasting bloodglucoseLDL cholesterol

HDL cholesterol

Tiglycerides

TotalcholesterolDiastolic bloodpressureSystolic bloodpressurePhysical QOLscoreMental QOLscoreKnowledgescore

Components of Self Management Education

Assessment of the individual’s

specific education needs

Educational and behavioral

intervention directed toward

helping the individual

achieve identified self-

management goals

Identification of the

individual’s specific

diabetes self-

management goals

Effects of Diabetes SME on Glycated Hemoglobin

Stages of SME/Behavior Modification

The Transtheoretical Model of Behavioral Change,

University of Rhode Islands, 2001.

Kumpulan sasaran

1.Pesakit yang baru didiagnosa dengan penyakit NCD

2.Pesakit NCD yang tidak mencapai tahap kawalan penyakit yang disarankan

3.Pesakit dengan komplikasi penyakit tertentu e.g Chronic Kidney Disease, Stroke dan lain-lain

4.Pesakit dengan masalah psikososial e.g Depression, Stress

Turut melibatkan ahli keluarga dan penjaga pesakit NCD

10 Modul Latihan Pegendalian NCD Untuk Paramedik

Bahan

•Buku

•CD-rom

•Flipcharts

•Model kaki dan makanan

• Presentasi Power Point

•Buku rekod pemakanan

• LCD

•Komputer

11 Modul Latihan Pegendalian NCD Untuk Paramedik

Buku dan CD

12 Modul Latihan Pegendalian NCD Untuk Paramedik

Flipcharts

13 Modul Latihan Pegendalian NCD Untuk Paramedik

Model Kaki

14 Modul Latihan Pegendalian NCD Untuk Paramedik

Penyampaian

•Pilih topik

•Tempoh masa •Satu jam •Separuh hari •10-15 minit setiap pagi

•Kekerapan •Sekerap mungkin

•10-15 minit setiap pagi •1 jam setiap minggu •½ hari setiap bulan

15 Modul Latihan Pegendalian NCD Untuk Paramedik

Penyampaian

•Di ruang menunggu

•Bilik Konsultasi

•Pusat Sumber

•Bilik seminar

16 Modul Latihan Pegendalian NCD Untuk Paramedik

Synthesis of Self Management Education (SME) Theories

Age

Physical condition

Education

Experiences Hierarchy of

Needs

Knowledge

Teaching Style SUCCESSFUL

SME

Approaches to teaching SME

Method Example

Presentation

Lectures, demonstrations, use of overheads, slides,

charts, guest presenters, expert testimony, resource

panels

Discovery

Self-reflection, experiments, group discussions,

observations, task evaluation, brainstorming

Games

Drama, role-playing, simulations, contests

Media

Television, movies, radio

Teacher-absent

Individualized-learning, programmed learning,

distance education

Methods…Presentation

•Benefits

•Efficient delivery of large quantities of information •Good means of establishing interest

• Benefits

•Self-understanding through experience •Allows learners to find in themselves what they

already know or have the ability to know

SME Methods…Discovery

•Benefits •Affective learning; psychological/physical stimuli,

making learning enjoyable •Facilitates group learning •Uses the concepts of cooperation/competition •Knowledge/skill transfer

SME Methods…Games

• Benefits

•Provides accessibility to prominent people who could otherwise not present and give a personal appearance

•Tangible documentation •Sensory experiences •First-person views of history, geography, and

nature

SME Methods…Media

•Efficient delivery of information to a dispersed population

SME Methods…Teacher-absent

•Each interaction with the patient is an opportunity for the doctor and the other HCPs to teach, encourage, and reinforce chronic disease care.

•To make the collaboration between health care practitioner (HCP) and the patient possible, there should be “shared responsibility” in their respective tasks

AACE Medical Guidelines

• Emphasizes the different tasks of both the health care professional and the patient in maintenance of an intensive diabetes self-management

PROACTIVE

Patient

SUPPORTIVE

Health Care

Practitioner

Successful Intensive

Disease

Self-Management

+ =

P-performs blood glucose, blood pressure monitoring

consistently

R-records and tracks activities and diet

O-overcomes psychological barriers like stigma, feeling of

impending doom and others

A-adherent to medications, diet, exercise program and

avoidance of smoking

C-consistent with appointments with health care professionals

T-targets in treatment are being achieved

I-interacts, communicate with health care team on possible

barriers to therapy

V-values the clinical parameter that should be achieved

E- evaluates eye, feet and other possible organs that might

be affected

A PROACTIVE Patient

SUPPORTIVE Health Care Provider

Supervises the patient’s education on diabetes

U Utilizes processes and programs to evaluate the patient’s

adherence to treatment and effectiveness of self-care

P Prevents complications through emphasis of preventive measures

P Promotes adherence to guidelines adherence of the patient

O Observes outcome measurements and determines patient satisfaction and

quality of life by use of questionnaires

R Responds appropriately to patient needs after thoroughly evaluating the

patient’s concern every 3 months in a utilizable data format

T Trains the patient to do the procedures properly, utilizing skill evaluation

programs and objectively doing this semiannually

I Identifies errors and misconceptions in the knowledge, self-care behavior

and skills of the patients

V Verifies any difficulties that the patient may have in any area of the Intensive

Disease Self-Management System

E Establishes and maintain a regular follow-up schedule, defining the frequency

of the visits and assessing the patient’s ability to adhere to it

Patient Care Plan

•Prerequisites to initiation •Assess the patient’s education needs •Determine prerequisite knowledge for the accomplishment of patient education •Determine patient’s baseline knowledge •Relevance of knowledge and skills to be discussed

Patient Assessment

•Personal and socioeconomic information

•Baseline Diabetes Information

•Other medical information

• Lifestyle factors

•Nutrition information

•Education factors

Educational Patient Care Plan

•Important Points •Preventing complications •Self-monitoring and relapse prevention

•Preventing Psychologic Morbidities •Reasons for developing psychologic morbidities •% for each psychologic morbidity

Preventing Complications

•How risks of NCDs are recognized

•How the risks of NCDs may be effectively communicated

•How to promote healthy eating, weight loss, physical activity and appropriate medication

•How to reduce socioeconomic and cultural disparities in all these areas

•How to maximize benefits and minimize psychological and other risks of screening

Self-monitoring and Relapse Prevention

• Blood glucose self monitoring

• HbA1c testing (2-4 times/year)

• Patient education in NCDs management

• Medical nutrition therapy and education

• Annual eye exam

• Annual foot exam

• Blood pressure measurement

• Other related annual blood test

• Annual screening for disease complications

Reasons for Developing Psychologic Morbidities

•Adverse effects of the medications being used

•The escalating cost of treatment

•The onset of chronic disease complications

•A change and limitation in the functional abilities

• Lack of support from the family

•Fluctuations in physical well-being

•Mood associated with changes in blood glucose etc

Goals of SME

•To optimize metabolic control

•Prevent acute and chronic complications associated with NCDs

•Optimize quality of life while keeping costs acceptable

Qualities of a Good Regimen

•Adaptable to meet the patient’s lifestyle and needs

•Balances the risks and benefits of therapy

•Allows frequent evaluation and modification

Factors that facilitate Compliance

• Inclusion of patient’s support network in the treatment team

• Definition and agreement on treatment goals and self-care behavior

• Correct choice of regimen for the patient and its adaptation to his lifestyle

• Allowing patient to practice self-care behaviors

• Monitoring the efficacy and outcomes of the behaviors that have been agreed to

• Redefining goals as necessary

• Renegotiating care plans if current plan has not been successful

Through regular follow-ups, changes can be made and the patient’s decision-making and problem-solving skills will be enhanced, promoting a greater sense of control over their chronic diseases.

TAKE HOME MESSAGES:

Pendidikan kesihatan kepada pesakit NCD penting untuk memperkasakan pesakit

Gunakan masa semasa pesakit menunggu giliran rawatan

Guna bahasa ringkas dan mudah

Kaedah pendidikan kesihatan yang bersesuaian dengan pesakit

Tempoh masa yg pendek tapi kerap

Buat perancangan awal & jadual pendidikan kesihatan

Penglibatan semua anggota kesihatan secara bergilir Doktor, Paramedik ,Pegawai Pemakanan, Pegawai Kerja

Sosial, Pegawai Farmasi dan Jurupulih anggota/ Fisioterapis

39 Modul Latihan Pegendalian NCD Untuk Paramedik

40 Modul Latihan Pegendalian NCD Untuk Paramedik