pengurusan sesi pendidikan kesihatan
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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
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