Download - Wk 10 lecture 1 pp
FALL 2011: WEEK 10 , LECTURE 1
PTHA 1301: The Profession of Physical
Therapy
Today’s Theme Song
SURPRISE!!!• “Are those the people who do those
HORRIBLE gyrations???”• - from my sweet mother, HUGE fan of
Elvis
Goals for Today: Motivation & The Interdisciplinary Team
Discuss the role of health care professionals in promoting motivation and adherence
Describe how the role of the PT/PTA can differ depending on the therapy setting
Differentiate between the role of the PTA/PT and other health care professionals
Differentiate between various health care professionals
Recognize the multi-disciplinary team approach to health care
Research Paper Due Dates
Rough Draft of Visual Presentation due Tuesday 11/01/11 at 2:30pm via Blackboard or in
personPrinted Draft w/your edits & at least 1 peer
edit show Elaine 11/03/11 by 3:30pm
Printed Final Paper (7-10 pages) due Tuesday 11/08/11 by 2:30pm
FINAL Visual Presentation & Handout due Tuesday 11/08/11 by 2:30pm via Blackboard
and/or hard copy
Research Paper Requirements
APA Format – writing style guidelines published by The American Psychological Association
7-10 pages (Introduction, Body, Conclusion) PLUS: Title Page & Works Cited (Reference Page)
Double Spaced 1” margins on all sides 12 point, Times New Roman font (per APA
recommendations)
At least 5 sources cited in your paper One of the 5 sources must be a personal interview
Research Presentation Requirements
8-10 minutes in length
Utilize a visual aide during your presentation Power Point Flip Chart Prezi
Prepare & issue a written handout for the class AT LEAST 1 page Be creative!
Test #3 is THIS Friday 11/04 at 10am
Disability – Psych Aspects book – Ch 10Chronic Conditions – Psych Aspects book – Ch
11Personality – MBTI + Lecture notes after
MBTIMotivation – Psych Aspects book – Ch 6The Interdisciplinary Team
Intro book – pgs 27-38 Intro book – pgs 45-47
Jackie’s information – Abbreviations O-symbols (?)
Promoting Motivation and Adherence
Clients tend to be motivated to strive towards goals That are important and relevant to them That they believe/hope are possible
Clients tend to adhere to programs that are Not too difficult Not too costly Not too time consuming Are consistent with their health belief system
Concepts to Enhance Motivation and Adherence
Education and empowermentClient-centered care
Ask clients to identify questions and problems in their own words Facilitate open dialogue Educate clients about how to be active participants
Goal settingFeedback and follow-upPeer support groupsFunctional programs Collaboration
Client-Related Barriers to Collaboration
Non-adherenceImpairments and disabilitiesLack of interest in collaborationPerception that clinician has lack of timeUncertainty regarding success of treatment
Clinician-Related Barriers to Collaboration
Inadequate knowledge about how to collaborateUnwillingness to relinquish/share powerPaternalistic perspectiveFailure to consider pre-morbid lifestyle and history
Strategies to EnhanceMotivation and Adherence
Health Belief Model
Transtheoretical Model for Health Behavior Change (Stages of Change)
Motivational Interviewing
The Five A’s Behavioral Intervention Protocol
There are MANY more strategies/behavioral techniques
Strategy 1 to Enhance Motivation/Adherence
Health Belief Model
Focuses on psychological theories of decision making Health behaviors & choices are influenced by the value people
place on a potential outcome & their belief that a certain course of action will result in a desired outcome
In order to change behavior, must first be ready to make a change Believes that the value of making the change is stronger than the
consequences of not making the change To motivate patients to make the suggested changes, patients’
beliefs must align with our view that Western medicine provides solutions
Strategy 2 to Enhance Motivation/Adherence
Transtheoretical Model for Health Behavior Change
(Stages of Change)
Focuses on motivation Change in health behavior is a process that takes time People move through various stages of readiness to change
Pre-Contemplation (No plans to begin change) Contemplation (Aware of need to change/plan to in next 6 mos) Preparation (Plan to take action in near future) Action (Implementing the change) – appears “Motivated” Maintenance (Change is kept) – 6 mos to 5 yrs – relapse is Termination (Change is integrated) – Goals reached! Confident
they will not return to previous unhealthy behavior Relapse appears to be a necessary element in the process. It must
be addressed to allow the patient to begin anew
Strategy 3 to Enhance Motivation/Adherence
Motivational Interviewing Based on the belief that patients are responsible for their own actions
and health AND for changing their health behaviors Client-Centered, evidence based, directive counseling approach Based on the transtheoretical model for health behavior change,
follows 4 key counseling principles Express empathy (Readiness to change comes from w/in patient) Develop a discrepancy (between current unhealthy behaviors and
goals/values they might strive to achieve) – (Self-determination & commitment to change rests within the patient)
Roll with resistance (PTA does not directly interfere w/client resistance. Coercion, persuasion, & confrontation are counterproductive)
Support self-efficacy (PTA supports & communicates the belief that the patient IS ABLE to effect change through a partnership rather than paternalistic relationship)
Reflective listening, open ended ?’s, affirming, & summarizing are key “Tell me what you already know about diabetes and how it is treated?” PTA affirms and supports all facets of the conversation to change!
Strategy 4 to Enhance Motivation/Adherence
The Five A’s Behavioral Intervention Protocol Taken from other models This strategy has been shown to be more successful in promoting
patient motivation/adherence than information and advice alone
Address the issue (get patient’s attention, name the problem, & present the need for intervention)
Assess the patient (determine where patient is in the stages of change & identify potential barriers)
Advise the patient (include traditional medical role of giving info & educating the patient to make change/explain pros & cons of change)
Assist the patient to make change (negotiate an agreeable plan of care)
Arrange for follow-up (schedule another appointment to review progress, address barriers, and renegotiate the protocol)
The PTAas a Member of the Health Care Team
Variety of Physical Therapy Settings
Acute Care Facilities Primary Care Facilities
Subacute Care Facilities Outpatient Care Facilities
Rehabilitation Hospitals Long Term Care Facilities(ChronicCare)
Hospice Care Facilities Home Health Care
School System Private Practice Facilities
The Health Care Team
Intradisciplinary Members work together within same discipline (PT/PTA) Other disciplines are not involved
Multidisciplinary Members work separately and independently in their different
disciplines, without collaboration
Interdisciplinary Members work TOGETHER within ALL disciplines to set goals ALL members collaborate but interventions may be done
separately *** This type of team is the most efficient and successful to
patient outcomes.
Possible Team Members
PTAPTCOTAOTRSLPRNLVNMDPACNP
• Recreational Therapist• Chiropractor• Pet Therapist• Therapy Aide• Clinic Office Manager• CNA• Orthotist/Prosthetist• LSW• ATC• Physical Therapy
Volunteers• SPTs/SPTAs• Home Health Aides
Behavior ChangeSmall Group Activity: Background Information
Ted is a 45 year old construction worker who has come to you for treatment of low back pain. This is not his first time receiving treatment. You find that he has been to PT, a nutritionist, and a back school in the past. He admits that he had trouble following through with the home programs. Ted continues to be 50 pounds overweight and smokes a pack of cigarettes per day. He is divorced and at the end of the day, he likes to sit in front of the TV and “have a few beers.”
Small Group Activity: Instructions
Divide into 3 groups of 5
Use the assigned method to attempt to change the patient’s behavior
Consider the pros and cons of your assigned method
Problem solve in your group and prepare to present in class