HEALTHY AND FULFILLING LIFESTYLE

Transcription

1 Reference Guide for Individual Patient Education Keeping a Healthy and Fulfilling Lifestyle Educational topics: 1. Healthy and Fulfilling Lifestyle Health and COPD Healthy Life Habits o No smoking o Medication compliance o Healthy diet o Exercising and physical activity o Good nights sleep o Satisfying sex life o Leisure activities o Planning of trips 2 nd Edition 2006 Authors: D. Nault, R.N., M.Sc. M. Sedeño, M.M. A. Joubert, B.Sc. J. Bourbeau, M.D., M.Sc., F.R.C.P.C. Montreal Chest Institute of the McGill University Health Center (MUHC) 1st edition authors: V. Perreault, R.N. M.Sc. D. Nault, R.N. M.Sc. J. Bourbeau, M.D., M.Sc., F.R.C.P.C. Montreal Chest Institute of the Royal Victoria Hospital

2 General Objective The content of this section aims to help the COPD patient and family to make the appropriate changes in their lifestyle to live better with COPD. Patient / Family Specific Objectives 1. To define what it means to be healthy with COPD 2. To adopt and maintain healthy life habits: To quit smoking (if smokes) To take medications as prescribed and on a regular basis To maintain healthy nutrition habits and a healthy weight To do on a regular basis physical activities and/or follow a formal exercise program To have good night s sleep To have satisfying sex life To practice on a regular basis one or more recreational activities To plan trips (if wants to travel) Living Well with COPD resources Reference guide for individual patient education Keeping a Healthy and Fulfilling Lifestyle, section Healthy and Fulfilling Lifestyle Patient/family learning module: Keeping a healthy and fulfilling lifestyle Summary guide, p. 29 Flipchart: sections: - Healthy lifestyle Health and COPD 1. a. Identify with the patient/family what health means to him*. [1] b. Discuss with the patient/family that it is possible to be healthy when having COPD. [2, 3] Can express clearly his meaning of health by reinforcing the fact that it is possible to be healthy when having COPD What does health mean to you? Do you think it is possible to be healthy when you have COPD? Explain. 2. Review with patient/family healthy behaviours to be adopted and integrated in everyday life to live well with COPD (use the flipchart). [2] Describe the healthy behaviours to be adopted and integrated in everyday life to live well with COPD What do you do to stay healthy? Are there any other changes in your lifestyle you should do to live better with COPD? Which ones? *For simplicity, the pronouns 'he', 'his' and him in this reference guide will refer to both males and females. It is not intended to isolate any one particular gender. Individual Reference Guide: Prevention and Management of COPD Exacerbations. October 22, 2006 Page 2 of 9

3 Healthy Life Habits: Smoking Cessation and Avoiding Second Hand Smoke 1. a. If patient smokes, determine his stage of change (Prochaska). [1] Expresses at what stage he is for quitting smoking Do you still smoke? If you still smoke, do you think of quitting smoking? If you are thinking about it, are you ready to quit? b. If he is ready to quit or has already quit smoking (stage of preparation, action or maintenance), review the goal and benefits and reinforce the plan previously established [5, 7]. quitting smoking and participates in the elaboration of the plan to quit smoking or agrees to continue following the pre-established plan Do you have a date for quitting? Can you tell me what will be the benefits of quitting smoking on your health condition? How can we make a plan to help you to quit smoking? Are you willing to continue following your plan? c. If he is not ready (stages of pre/contemplation) - help him express his feelings, concerns, perceived benefits and risks [1,3]. Expresses his feelings and concerns about his habit of smoking and the need to quit What are your feelings and concerns about quitting smoking? Do you see any benefits for you if you stop smoking? What are the risks if you continue to smoke? - give him pertinent written information to read if it s not done yet. [10] Agrees to read and consult written information Are you planning to read the written information? 2. If a family member smokes stress the importance for the patient/family to live in a smoke-free environment. [3, 7] Agrees with the feedback and reinforcement in regards to the importance of living in a smoke-free environment Can you tell me why it is important for both of you to live in a smoke-free environment Do you see any benefits for you to live in a smoke free environment? What are the risks for your partner or loved one or friend if you continue to smoke? 3. Explore how patient feels about asking people around him not to smoke in his presence. Provide examples of how he could deal with that. [1, 3, 5] States that he feels comfortable in asking people around him not to smoke in his presence How do you feel about asking people around you not to smoke in your presence? Give me examples on how you would ask them not to smoke around you. 4. Evaluate the patient/family s level of self-efficacy with respect to his capacity to live in a smoke-free environment by quitting smoking and/or avoiding second hand smoke [6] Believes that he is able to live in a smoke-free environment by quitting smoking and/or avoiding second hand smoke If he smokes: Do you feel capable of quitting smoking? Do you feel capable of asking people around you not to smoke in your presence? Believes that living in a smoke-free environment will have a positive impact on his health If he smokes: Do you think that quitting smoking will have a positive impact on your health? Do you think that living in a smoke-free environment is good for you? Individual Reference Guide: Prevention and Management of COPD Exacerbations. October 22, 2006 Page 3 of 9

4 5. Refer the patient/family member to a smoking cessation expert if needed [9] Agrees to see an expert in smoking cessation if help is needed Have you met the expert for smoking cessation? Did it help you? Compliance with medications 1. Assess if patient is taking his medications as prescribed and on a regular basis. [1] Describes how he is taking his medications: type, frequency, dosage and timing Are you taking your medications as prescribed? For each medication, What dose and number of pills/puffs you need to take each time? How many times per day you need to take it? What helps you take your medications on a regular basis? What is preventing you from not taking your medications regularly? 2. Review with the patient/family the goal and benefits of taking the medications as prescribed and give reinforcement on the importance of taking them regularly. [2, 7] taking the medications as prescribed and the importance of being compliant with his medications Why should you take your medications as prescribed and on a regular basis? 3. Evaluate patient s level of self-efficacy in regards to taking medications as prescribed and on a regular basis. [6] Believes that he is able to take his COPD medications as prescribed on a regular basis. Believes in the benefits of the medications prescribed for COPD Do you think you are able to take your medications for COPD as prescribed on a regular basis? Do you believe that the medications prescribed for your COPD can stabilize or improve your symptoms? 4. Refer the patient to the physician and/or pharmacist if he needs more detailed information about his medications. [9] Agrees to meet with the physician and/or pharmacist Have you met your physician? Have you met the pharmacist? Healthy diet 1. Assess patient s perceptions related to nutrition (grocery and preparation of meals, feelings / symptoms while eating and after, concerns). [1] Expresses feelings, symptoms and concerns related to his nutrition. How do you organize yourself for doing your grocery? Do you have any problems with the preparation of your meals? Describe. How do you feel while you are eating? After? What can prevent you from eating properly? 2. Ask the patient/family what type of food they are currently eating, their hours of meals and what is the environment at meal times. [1] Describe the types of food they are currently eating, their meal times and the environment while eating. What types of food are you currently eating? What do you like to eat the most and the least? At what times during the day do you eat? Do you like eating? What do you do when you eat? Do you take your time? Explain. Individual Reference Guide: Prevention and Management of COPD Exacerbations. October 22, 2006 Page 4 of 9

5 3. Identify with the patient recent gains or losses in his weight. [1] Reports weight gains or losses that occurred in the last 3 months. Have you lost or gained weight in the past 3 months? How much weight did you loose or gain? 4. Explain to patient/family the goal and benefits of maintaining a healthy body weight and healthy nutrition habits. [2] maintaining a healthy body weight and healthy nutrition habits. Can you tell me why you should eat properly and maintain a healthy body weight? 5. a. Discuss with the patient/family the Canadian Food Guide recommendations. [2] Ask him to summarize the key elements from the discussion. [8] b. Elaborate with the patient an example of menu appropriate for him. [5,10] Describes the keys elements related to the discussion on the Canadian Food Guide recommendations. According to you, what are the most important recommendations included in the Canadian Food Guide? Participates to the elaboration of a menu appropriate in his case. Can you give me an example of menu appropriate for you? 6. Discuss with patient/family potential problems related to nutrition in COPD. [2] Describes potential problems that can prevent him from eating properly. What are the problems related to nutrition that COPD patients might face? 7. Discuss with patient/family strategies that can help to eat properly and save his energy when preparing meals, while eating and after. [2] Describes the strategies he can use to eat properly and save his energy in preparing meals or while and after eating. What are the strategies that can help you to eat properly and save your energy when preparing meals? When eating? After eating? 8. Evaluate patient s level of self-efficacy with respect to his capacity to keep a healthy diet [6] Believes that he is able to eat properly. Believes in the benefits of keeping a healthy diet. Do you think you are able to eat properly on a regular basis? Do you believe that keeping a healthy diet can have a positive impact in your condition? 9. Refer the patient to a dietician in case of obesity, when there is a risk of malnutrition or in the presence of concomitant health problems. [9] Agrees to see a dietician Have you met a dietician? Did it help you? Exercise and physical activity 1. a. Ask patient/family which activities he considers as exercise. [1] b. Ask patient/family which type of exercise he does presently and the frequency. [1] Describe the activities he considers as exercise and the ones that he does presently. Which activities do you consider to be exercise? Are you exercising presently? What type of exercise or physical activities are you doing? How many times per week are you doing your exercises? 2. If patient/family is ready to start exercising or he is already doing exercise, a. Review with him the goal and benefits of exercising. [2] exercising on a regular basis Are you ready to start exercising? Can you tell me why you should exercise? Why on a regular basis? b. Suggest what he can do to increase his level of physical activity or reinforce what he presently does. [5, 7] Participates in the elaboration of the plan to increase physical activity or agrees to continue doing his exercises. How can we make a plan to help you to exercise? Are you willing to continue to do your exercises? Individual Reference Guide: Prevention and Management of COPD Exacerbations. October 22, 2006 Page 5 of 9

6 3. If he is not ready to exercise, a. Help them to express his feelings and concerns. [3] b. Give them pertinent written information.[10] Expresses his feelings and concerns about exercising. Agrees to read and consult written information What are your feelings and concerns about exercising? Do you like exercising? Do you see any risks for you if you start to exercise? Do you plan to read the written information? c. Stress your belief that he needs to exercise on a regular basis and that this is possible for him. [3,7] Expresses agreement for feedback and reinforcement 4. Evaluate the level of self-efficacy with respect to his capacity to do exercise or physical activity regularly. [6] Believes that he is able to do exercise or physical activities on a regular basis Believes that exercising will have a positive impact on his condition. Do you believe you are capable of exercising or doing physical activities on a regular basis? Do you think that exercising is good for you? 5. Refer patient to a pulmonary rehabilitation program if he is motivated and has no contraindications to do it. [9] Agrees to be referred to a pulmonary rehabilitation program Have you been contacted by (or met) someone from a pulmonary rehabilitation team? Good sleep habits 1. Assess patient s cycle of sleep (bedtime, duration, positions to sleep) and sleep related problems. [1] Describes his cycle of sleep and the problems he is facing. At what time do you go to bed? How many hours do you sleep per night usually? What kind of positions do you sleep in? Do you sleep well usually? Do you have any problems to sleep? Describe. Do you have an idea of the reasons why you cannot sleep well? 2. Discuss with patient/family the goal and benefits of having good sleep habits. [2] having good sleep habits. Can you tell me why it is important to sleep well? 3. Discuss with patient/family strategies that can help to have a good night s sleep. [2,5] Describes the strategies he should use to have a good night s sleep. What do you do when you are not sleeping well or you cannot sleep? What should you do to sleep well? 4. Evaluate patient s level of self-efficacy with respect to his capacity to keep good sleep habits [6] Believes that he is able to keep good sleep habits Believes that having good sleep habits will have a positive impact on his health condition Do you believe you are capable of maintaining good sleep habits? Do you believe that having good sleep habits will help you to sleep better? Individual Reference Guide: Prevention and Management of COPD Exacerbations. October 22, 2006 Page 6 of 9

7 5. Refer patient to his physician if sleep problems persist. [9] Agrees to see his physician Have you met your physician for your sleep problems? Did it help you? Maintain a satisfying sex life 1. Assess patient/partner feelings, concerns, fears and needs in regards to their sex life in an individual basis. Have them share with each other. [1, 3] Expresses individually his feelings, concerns, fears and needs in regards to his sex life and share them with his partner How do you feel about sex? Do you have any concerns or fears related to your sexuality? What would you like to improve in regards to your sexuality? 2. a. Discuss with patient/partner the goal and benefits of having a satisfying sex life. [2] b. Demystify and normalize the fears around sexuality in COPD. [2, 3] having a satisfying sex life. Expresses agreement for normalization Tell me why having a satisfying sex life can be good for you 3. Discuss with patient/partner strategies that can help them to have a satisfying sex life (emphasize on preliminaries, strategies to reduce shortness of breath and facilitate intercourse). [2, 5] Participates in finding strategies to have a satisfying sex life. What strategies are you using or can you use to respond to your sexual needs and those of your partner? What strategies are you using or can you use to reduce your shortness of breath and facilitate intercourse? 4. Evaluate patient s level of self-efficacy with respect to his capacity of maintaining a satisfying sex life [6] Believes that he is able to maintain a satisfying sex life Believes that using the strategies discussed will help him maintain a satisfying sex life Do you believe you are capable of maintaining a satisfying sex life? Do you believe that using the strategies discussed will help you to maintain a satisfying sex life? Leisure activities 5. Refer patient to his physician / sex therapist if sex problems persist. [9] 1. a. Assess patient s/family s leisure activities he is involved in presently. [1] b. Ask patient which leisure activities he had to stop because of COPD and which ones he would like to restart. [1] Agrees to see his physician / sex therapist Lists all the leisure activities he is involved in, the ones he has stopped and the ones he would like to restart. Have you met your physician / sex therapist? Did it help you? What do you do as leisure activity? Are there any leisure activities that you have had to discontinue? Which ones? Why did you have to stop? Would you like to restart any leisure activity(ies)? Which ones? 2. Discuss with patient/family the goal and benefits of doing leisure activities. [2] taking time for leisure activities. Can you tell me why you should take time for leisure activities? 3. Discuss with patient/family possible leisure activities he can get involved in. [2,3] Lists at least three leisure activities that he can get involved in. Name a few leisure activities that are good for you and that you would like to do What are your strengths, the limitations and your abilities to do these leisure activities? Individual Reference Guide: Prevention and Management of COPD Exacerbations. October 22, 2006 Page 7 of 9

8 4. Plan with the patient the start of a new leisure activity that he will do regularly. [5] Chooses at least one new leisure activity that he will start to practice regularly. Which leisure activity are you ready to start and practice regularly? 5. Evaluate patient s level of self-efficacy with respect to his capacity of getting involved in one or more leisure activities [6] Believes that he is able to get involved in one or more leisure activities Believes that getting involved in leisure activities can improve his overall health condition and emotional well-being Do you believe you are capable of practicing one or more leisure activities on a regular basis? Do you believe that getting involved in leisure activities can have a positive impact in your health condition? Planning trips 1. Assess patient s interest in traveling, his concerns and fears. [1] Expresses his desire of travelling or not. Are you interested in traveling? Where would you like to go? What worries you about taking a trip? 2. Discuss with patient/family the goal and benefits of travelling. [2] traveling. What do you think travelling can do for you? 3. Plan with patient the trip he would like to do and discuss with patient/family what needs to be arranged in advance. [2, 5] Does the exercise of planning a trip through one mode of travel. How you would like to get there? (e.g. mode of travel) What are your strengths, limitations and ability to do this trip? Lists the essential elements that should be part of the travelling plan. What are the most important things you need to get and arrange before you can travel? 4. Evaluate patient s level of self-efficacy with respect to his capacity to plan a trip. [6] Believes that he is able to plan and go on a trip Believes that travelling will have a positive impact on his overall health Do you believe you are capable of planning and going on a trip? Do you believe that travelling will have a positive impact on your overall health? 5. Refer patient to his physician to get a summary note of his chart, updated vaccination status, applicable prescriptions and enough medication for the trip. [9] Sees his physician before going on a trip (enough time in advance) Do you have the summary note from your doctor, prescriptions and medications that you need? In case of O 2 and travelling by plane: Have you made arrangements for your in-flight oxygen? Have you been able to book a direct flight? Summary of the session 1. Ask the patient to summarize the key elements of what has been discussed in regards to healthy behaviors that need to be integrated in the daily life to live well with COPD.[8] Summarizes in his own words the key elements in regards to healthy behaviours that need to be integrated in the daily life to live well with COPD Can you tell me what are the most important changes in your lifestyle that you need to do to live well with COPD? Individual Reference Guide: Prevention and Management of COPD Exacerbations. October 22, 2006 Page 8 of 9

9 2. Provide to the patient constructive feedback and reinforcement on the adoption and integration of healthy behaviors needed to live well with COPD. [7] Expresses agreement for feedback and reinforcement Learning contract 1. Ask the patient to continue to integrate in his daily life the healthy behaviors needed to live well with COPD on his daily life. [5] Maintains healthy behaviours to live well with COPD. How are you doing in terms of? (Check for each healthy behaviour) Have you been able to continue with the plan we discussed? What are the problems you have had? **Educational Methods and other actions: 1 Learning needs assessment, 2 Interactive lecturing, 3 Building of ambivalence (motivational interview technique), 4 Demonstration and practice, 5 Learning contract, 6 On a scale of 1 to 10, ask the patient to determine his level of confidence, 1 = not confident at all and 10 = very confident, 7 Constructive feedback and reinforcement, 8 Summarizing information, 9 Reference to other health care professionals, 10 Give pertinent written information, 11 Case scenarios. Suggested Questions: Questions to evaluate patient s needs, comprehension of information, and outcomes. If you find negative results readdress issues in order to reach the specific objectives. Individual Reference Guide: Prevention and Management of COPD Exacerbations. October 22, 2006 Page 9 of 9