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