Applying the KAWA theoretical model to Breathlessness Management. Julie Burkin, Occupational Therapist, Lead Practitioner

Transcription

1 Applying the KAWA theoretical model to Breathlessness Management Julie Burkin, Occupational Therapist, Lead Practitioner

2 KAWA Model Michael Iwama

3 Reference [accessed ]

4 Key Principles Sense of person as an occupational being, considering circumstances as the person sees them Interprets a person s circumstances & clarifies rationale and application of OT within their specific social and cultural context Surrounding context of life can enable & disable people The person s life circumstances, environment, assets and liabilities are all inseparable parts of the person

5 Water life energy A person s life energy, represented in the model by water, is influenced by life circumstances, environment, assets and liabilities. When life energy or flow weakens the person is in a state of disharmony

6 Kawa Model Uses metaphor / image of river to symbolise life Self is the focus seen and treated in context of all elements in a person s life

7 Kawa Model life is like a river

8 Inseparable parts of the river Rocks - life circumstances Walls & bottom of river environment Driftwood assets & liabilities

9 Kawa Model Rocks, Walls, Driftwood

10 Rocks Life circumstances which act as impediments to life flow. Perceived by person to be difficult to change e.g. congenital conditions / sudden illness / injury (diagnosis of lung cancer) These impediments can be accentuated when situated against the walls of the river e.g. a chronic condition and the environment (breathlessness and having to manage stairs)

11 Walls and bottom of river Social environment those who share a relationship with the person e.g. family, friends, pets, deceased persons Physical environment in which the person lives and interacts

12 Driftwood Personal attributes & resources e.g. values, personality, special skills, immaterial and material assets, living situation Can positively or negatively affect life flow

13 Spaces in river opportunities for change Spaces between obstructions Factors sustaining person s hope and desire to continue Opportunities to build upon

14 Effect of components on flow

15 Gaps in the river potential targets for OT interventions

16 Gaps in river importance of understanding context to set priorities

17 Stemming further obstruction & maximising life flow

18 The Process of using the model Appreciating the person in context Clarifying the context Prioritising issues according to the person s perspective Assessing focal points of OT intervention Intervention Evaluation

19 KAWA Model used with Breathlessness Breathlessness Management Kawa Model Person needs to be considered in social and cultural context in order to understand the impact of breathlessness Interprets a person s circumstances within person s particular social and cultural context

20 KAWA Model used with Breathlessness Breathlessness management KAWA Model Person seen in and treated in context of all elements in the person s frame Breathlessness influenced by all elements in a person s life

21 KAWA Model used with Breathlessness Breathlessness management KAWA Model Surrounding context can enable and disable the person with breathlessness e.g. family attitudes to / perceptions of breathlessness Surrounding context can enable and disable the person

22 KAWA Model used with Breathlessness Breathlessness management KAWA Model Breathlessness impacts greatly on a person s life energy Water is life s energy. When life energy or flow is weakened, the person is unwell or in a state of disharmony

23 KAWA Model used with Breathlessness Breathlessness management KAWA Model We may not take the breathlessness away but we can help the person to manage it more effectively, enabling a sense of control As some of the river contents are removed and the structure expands the channels become wider and the water is liberated to flow more strongly and fully

24 KAWA Model used with Breathlessness Breathlessness management KAWA Model Essence of intervention is to enhance or enable control and mastery over the symptom, thus reducing it s impact Essence of Occupational Therapy is to enhance or enable greater life flow

25 KAWA Model used with Breathlessness Breathlessness management Often build on these with the person who is breathless e.g. identifying a selfmanagement strategy that they are already using to increase motivation to use others KAWA Model Spaces between obstructions are factors sustaining person s hope of seeing a new day

26 KAWA Model used with Breathlessness Breathlessness management KAWA Model Emphasis on what can be done to manage breathlessness can help to reduce anxiety and increase confidence Water naturally flowing through these spaces can work to erode the rocks and river wall & bottom

27 KAWA Model used with Breathlessness Breathlessness management KAWA Model Management of breathlessness must be flexible & adaptable to respond to changing needs / give a range of strategies for this complex symptom Concepts and contextual application of the Kawa model are flexible and adaptable

28 Case Study Mr X 71 year old male, retired COPD diagnosed 1 year ago Lives alone in sheltered accommodation house Separated from wife 2 years ago Son lives locally with wife and child History of alcohol addiction gave up 1 year ago Gave up smoking recently Has had 18 admissions for SOB in 6 months Enjoys fishing but no longer feels able to go

29 Mr X - Rocks Breathlessness secondary to COPD Can t play with grandson Has long standing problem with alcohol addiction but gave up 1 year ago Panic / anxiety related to SOB 18 admissions in last 6 months Wondering if life is worth living Feels lonely and isolated

30 Mr X River walls & bottom House stairs and bathroom upstairs only Separated from wife In sheltered accommodation activities available but feels too SOB to attend Financially struggling due to increase in fuel bills of winter

31 Mr X - Driftwood Fear of breathlessness Am I going to die breathless Perception of being a burden to family Decreased confidence in abilities Determination has given up drinking and smoking Pride wants to be independent and help self

32 Mr X - Water Water continues to flow but to a lesser extent through seams and gaps Substantial obstructions in the form of rocks, driftwood and river walls in bottom Obstructions constructing flow Mr X not functioning to full potential

33 Mr X - spaces Has resilience & determination given up alcohol and smoking Opportunities for education Wants to manage symptom Keen to engage with other but just feels unable

34 Intervention - rocks Educate re: SOB & give strategies Suggest energy conservation principles to aid time spent with grandson Re-assure patient that strategies will reduce anxiety and increase sense of control Acknowledge patient resilience in continuing to manage alcohol addiction Put in touch with local support services (AA) Refer to local hospice day therapy

35 Intervention walls & bottom Environmental assessment Acknowledge loss of life partner Explored possibilities of getting back into activities Pacing advice given to help increase activity tolerance Referred on to welfare advisor re: assessment for relevant benefits

36 Interventions - driftwood Challenge misperception Am I going to die breathless Reassured breathlessness is not harmful Met with family to facilitate communication Gradual engagement in activity and exercise to increase confidence Set realistic goals Managed expectations by acknowledging SOB will not be eliminated Used motivational interviewing strategies to help with sense of mastery over breathlessness

37 Outcome of interventions Managed to remove some of the rocks and driftwood Reduced impact of river walls and bottom Channels of river have become wider Mr X s life force has been liberated to flow more strongly and fully

38 Mr X - outcome 2 re-admissions in 4 months Using strategies with good effect Attending day therapy at hospice Going fishing with grandson Uses local radio station to aid management of SOB and panic in the night Anxiety much reduced Using diary to aid management of mood

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