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P - Informed Self-Management

Current Canadian Practice Profile Clinical Practice Guidelines Although no SCI-specific CPGs exist regarding the practice of patient education or the most effective methods for facilitating self-management, there is some recognition that education is an important element to manage or better prevent secondary complications. Specific CPG examples from other medical issues include: 1. “Provide individuals with SCI, their families, significant others, and healthcare professionals with specific information on effective strategies for the prevention and treatment of pressure ulcers.”7 2. “Educational programs for bowel management should be structured and comprehensive, should consider the home setting and available resources, and should be directed at all levels of healthcare providers, patients, and caregivers. The content and timing of such programs will depend on medical stability, readiness to learn, safety, and related factors. An educational program for bowel management after SCI should include…” various content areas8 Educational Resources 1. 5/13 sites report using specific resources which include: • SCI Canada’s Life After a Spinal Cord Injury • Canadian Spinal Research Organization’s After and Beyond Manual and After and Beyond Manual Journal • Paralyzed Veterans of America’s Yes You Can • Spinal Cord Injury Rehabilitation Evidence (SCIRE) website (www.scireproject.com). 2. Online resources: • SCI-U eLearning modules of the University Health Network, Toronto (www.sci-u.ca) • Education resources at the Institute for Rehabilitation Research and Development, Ottawa (www.irrd.ca/education/). Assessments Standardized or routine use of assessment tools that focus on educational delivery, and their effectiveness for individuals, are infrequent in rehabilitation settings. The Needs Assessment Checklist,9 a system which indicates the degree to which patients feel they have achieved the knowledge and skills needed, in nine core areas, is conducted at only 16.7% (2/12) of sites. Respondents noted no other assessments. In general, patient-reported outcomes - such as measures of self-efficacy (e.g., Moorong Self-Efficacy Scale10), or those that would assess the effectiveness of the education delivered - would be very useful to inform the education process and to determine the desired effect of facilitating informed self-management. Leaders in Patient Education and Informed Self-Management 1. Tony Burns, MD (Physiatry), Toronto: Led the development and implementation of Spinal Cord Essentials, a comprehensive and integrated approach to patient education that ensures patients are active participants. 2. Mary Mark, RN MHS (Clinical Education), Edmonton: Developing innovative ways to ensure adult education methods are used effectively by staff through her position as a clinical educator. 3. Sandra Mills, MEd (Clinical Education), Toronto: Patient and family educator with a focus on resource creation as well as staff education, thereby enabling more effective point-of-care education. 4. SCI Knowledge Mobilization Network (SCI KMN) team of Transformational Specialists (Cyndie Koning, PhD (Rehabilitation Science), Edmonton; Anna Kras-Dupuis, RN, London; Marie Thérèse Laramée, MSc, Montréal; Valérie Lemay, erg. MSc, Québec City; Suzanne Nicol, RN, Calgary; Raj Parmar, RN, Calgary; Carol Scovil, PhD (Mechanical Engineering), Toronto): Developed, standardized and are implementing best practices in patient education related to pressure ulcer prevention and management; and employing patient-reported outcomes related to the perceived effectiveness of education delivery, as a way to inform quality improvement. 5. John Shepherd, MBA (Health Promotion & Knowledge Translation), Toronto: Creating self-management tools, such as the interactive eLearning series SCI-U, and a toolkit resource to facilitate interactions with primary care providers. 6. Dalton Wolfe, PhD (Neuroscience), London: Evaluating the utility and effectiveness of self-management tools in real-world settings, focused on innovative technologies. Key Practice References • Glasgow RE, Davis CL, Funnell MM, Beck A. Implementing practical interventions to support chronic illness self-management in healthcare settings: lessons learned and recommendations. Jt Comm J Qual Saf. 2003;29(11):563-74. • Lorig K, Holman HR, Sobel D, Laurent D, González V, Minor M. Living a Healthy Life with Chronic Conditions (3rd Edition). Boulder, CO: Bull Publishing; 2006. • Ljungberg I, Kroll T, Libin A, Gordon S. Using peer mentoring for people with spinal cord injury to enhance self-efficacy beliefs and prevent medical complications. J Clin Nurs. 2011;20(3-4):351-8. • May L, Day R, Warren S. Evaluation of patient education in spinal cord injury rehabilitation: Knowledge, problem-solving and perceived importance. Disabil Rehabil. 2006;28(7):405-13. • Potter PJ, Wolfe DL, Burkell JA, Hayes KC. Challenges in educating individuals with SCI to reduce secondary conditions. Top Spinal Cord Inj Rehabil. 2004;10(1):30-40. • Wolfe DL, Potter PJ, Sequeira KAJ. Overcoming Challenges: The role of rehabilitation in educating individuals with SCI to reduce secondary conditions. Top Spinal Cord Inj Rehabil. 2004;10(1):41-50. INFORMED SELF-MANAGEMENT | PARTICIPATION 163


P - Informed Self-Management
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