Download Kuliah 32 -Pendidikan Bersepadu

PENGURUSAN SESI
PENDIDIKAN KESIHATAN
ANJURAN :
BAHAGIAN KAWALAN PENYAKIT
BAHAGIAN PEMBANGUNAN KESIHATAN KELUARGA
Modul Latihan Pegendalian NCD Untuk Paramedik KKM
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Pendidikan kesihatan adalah usaha untuk menimbulkan
perubahan tingkah laku hidup sihat, baik lingkungan
masyarakat dan sosial.
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)
Modul Latihan Pegendalian NCD Untuk Paramedik
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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
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Self management Education (SME)
• Adalah satu proses :
• Kollaborasi
• Interaktif
• Berkembang
• Melibatkan pesakit (& keluarga) serta Pendidik
• Mengajar pesakit supaya boleh mengendalikan
penyakit kronik mereka sendiri
dengan baik
Modul Latihan Pegendalian NCD Untuk Paramedik
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Change in clinical data, QOL Scores, & diabetes
knowledge
5
HDL
PQS
0
A1C
DBP
-5
SBP
MQS
KS
A1C
Fasting blood
glucose
LDL cholesterol
HDL cholesterol
-10
Tiglycerides
LDL
-15
TC
-20
-25
FBS
-30
-35
TG
Total
cholesterol
Diastolic blood
pressure
Systolic blood
pressure
Physical QOL
score
Mental QOL
score
Knowledge
score
Pre- to Post-Program Change in Clinical Data, QOL Scores, and Diabetes
Knowledge (All sites)
Hogue V, et al. Diabetes Spectrum 2003
Components of Self Management Education
Assessment of the individual’s
specific education needs
Identification of the
individual’s specific
diabetes selfmanagement goals
Educational and behavioral
intervention directed toward
helping the individual
achieve identified selfmanagement 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
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Bahan
• Buku
• CD-rom
• Flipcharts
• Model kaki dan makanan
• Presentasi Power Point
• Buku rekod pemakanan
• LCD
• Komputer
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Buku dan CD
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Flipcharts
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Model Kaki
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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
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Penyampaian
• Di ruang menunggu
• Bilik Konsultasi
• Pusat Sumber
• Bilik seminar
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Synthesis of Self Management Education (SME) Theories
Knowledge
Teaching Style
SUCCESSFUL
SME
Age
Physical condition
Education
Hierarchy of
Experiences
Needs
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
SME Methods…Discovery
• Benefits
• Self-understanding through experience
• Allows learners to find in themselves what they
already know or have the ability to know
SME Methods…Games
• Benefits
• Affective learning; psychological/physical stimuli,
making learning enjoyable
• Facilitates group learning
• Uses the concepts of cooperation/competition
• Knowledge/skill transfer
SME Methods…Media
• 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…Teacher-absent
•Efficient delivery of information to a dispersed
population
•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
A PROACTIVE Patient
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
SUPPORTIVE Health Care Provider
processes and programs to evaluate the patient’s
U Utilizes
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
outcome measurements and determines patient satisfaction and
O Observes
quality of life by use of questionnaires
appropriately to patient needs after thoroughly evaluating the
R Responds
patient’s concern every 3 months in a utilizable data format
Trains the patient to do the procedures properly, utilizing skill evaluation
T Supervises
the patient’s education on diabetes
programs and objectively doing this semiannually
I
V
E
Identifies errors and misconceptions in the knowledge, self-care behavior
and skills of the patients
Verifies any difficulties that the patient may have in any area of the Intensive
Disease Self-Management System
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
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