1. FACTORS THAT INFLUENCE
A CHANGE IN BEHAVIOUR
Emily Moore
TO INCREASE THE HEALTH Calle Linden
OF HEART FAILURE The Dinh Thi
PATIENTS

2. FACTORS INFLUENCING SELF -CARE
Motivation Knowledge
Don’t know what to do
Hard to change habbits
Don’t know how to do
See no reason Have difficulty learning
Decreased memory
Insufficient self-care
Easily tired
Fatigue
No opportunities to teach patients
Not sufficient knowledge to teach patients
Barriers Nurse s responsibilities

3. WHY SELF-CARE?
 Cost-ef fective way to treat patients
 Decreased risk for readmission
 Shorter stay at hospital
 Improve situations in everyday life
 Provide the patients with active decisions
 Gives the patient a feeling of control
 Improving compliance to treatments
 Better understanding for treatments gives an improved compliance

4. FACTORS INFLUENCING SELF -CARE
 Removing barriers
 Chronic degradation
 Physical exercise may reduce symptoms
 6MW
 Organizational improvements/ Nurse s responsibilities
 Heart failure receptions
 Individual assessment of opportunities
 Improving motivation

5. TOOLS FOR IMPROVING PATIENTS
KNOWLEDGE
 Telephone-delivered education
 Individual with follow up
 The patient can be at their home
 Significant improved knowledge
 (Baker, Darren 2011).
 Web-based education
 Increases patients access to knowledge and possibility to share
information
 Requires close to non experience using computers

6. TOOLS FOR IMPROVING PATIENTS
KNOWLEDGE
 Video educations
 Patients are free to choose whenever they wish to learn
 Improved compliance to self-care
 (Albert, Buchsbaum & Li, 2007)
 Education session at hospital
 Ensure the patient receive information prior to discharge
 Reduced the risk for readmission
 (Krumholz et al., 2002)

7. MODEL OF IMPROVEMENT
 Helping patients change behavior is an important role for
family physicians
 Change interventions are especially useful in addressing
lifestyle modification for disease prevention, long -term
disease management and addictions.
 The concepts of “patient noncompliance” and motivation
often focus on patient failure.
 Understanding patient readiness to make
change, appreciating barriers to change and helping patients
anticipate relapse can improve patient satisfaction and lower
physician frustration during the change process.

8. PLAN
 1 . What change are we testing - what is the objective of the
test?
 2. Who is included in the test - who will be involved in the
testing process (nurses, QI team, staf fing) and on whom will
the test be conducted (patients with urinary incontinence)?
 3. When are we testing (start and end date)?
 4. Where are we testing?

9.  To change behavior, the patient must understand what to do
and how to do it. The patient needs enough knowledge to
adjust the treatment or prevention regimen in response to
changing circumstances.
 Learning relies heavily on the educator's ability to adapt
teaching strategies to the individual and on the patient's
ability to process information. Because poor glycemic control
and cognitive dysfunction are associated, it is among the
numerous factors that can af fect the ability of the patient
with diabetes to process information.

10. DO
 Doing the test.
 Collecting data for analysis - complete the chart
audits, collect whatever data is needed to help complete the
quality picture.
 Carrying out the Change - work the plan.
 Documenting problems - note any problems encountered
along the way. This will assist you in analyzing this cycle and
in avoiding problems in the future.
 Collecting Data - what information are you finding as you work
the plan?
 Beginning Analysis - make observations and begin analyzing
the findings and continue to document expected and
unexpected observations along the way.

11. STUDY
 In this phase an organization should study the data and
determine what was learned.
 List out problems, successes and surprises specifically so that
you can substantiate your conclusions and have the list as a
resource for future QI cycles.

12. ACT
 It is important at this stage to set up a specific plan with
detailed action steps that will help maintain or hold any gains
and that improvements continue over time.
 In the ACT stage, organizations also should establish a new
plan for next PDSA cycle and begin the cycle over again.
(continue to explain patient motivation of techniques that
have been developed for influencing patient behavior.)

13. CLINICAL MICROSYSTEMS
CLINICAL MICROSYSTEM TOOL
Ten success characteristics
1. Leadership
Setting and reaching collective goals, and to empower individuals
autonomy and accountability
• Ask -- raise the issue
• Advise -- increase awareness of risk and benefits related to behaviour
• Assist -- help the patient to identify a negotiated SMART
(specific, measurable, achievable, realistic, timed) goal related
to behaviour change and signpost if appropriate.
2. Organizational suppor t
The larger organization looks for ways to suppor t the work of the
Microsystem
3. Staf f focus
Expectations of staf f are high regarding per formance, continuing
education, professional growth, and networking

14. 4. Education and Training
Of fering training and education courses on the management
and proper treatment of heart failure
Processes to change lifestyle
5. Interdependence
The interaction of staf f is characterized by
trust, collaboration, willingness to help each other, appreciation
of complementary roles, respect and recognition that all
contribute individually to a shared purpose .
6. Patient Focus
The primary concern is to meet all patient needs –
caring, listening, educating, and responding to special requests,

15. 7. Community and Market Focus
Establish innovative relationships with the community; The
Microsystem is a resource for the community; the community
is a resource for the Microsystem
Initiatives in the community
8. Performance Result
Performance focuses on patient outcomes, avoidable
costs, streamlining delivery, using data feedback
9.Process Improvement
Learning and redesign is supported by the continuous
monitoring of care, use of benchmarking, frequent tests of
change
10. Information and Information Technology
Technology facilitates ef fective communication

16. NICE- National Institute for Health and Clinical Excellence.
Let's Get Moving initiative 2007
-recommendations for health professionals on interventions for
patients
e.g.
• learning to spot things that trigger or reinforce the
unwanted behaviour
• setting goals and planning how to achieve them
• building confidence to make important and wanted changes
• self-monitoring
• creating SMART action plans
• building social support through signposting
• rewarding success.

17. Four commonly used methods to increase physical activity
 Brief interventions – advice delivered by GPs and other non -hospital-based
health professionals.
 Exercise referral schemes – referral to a tailored physical activity
programme.
 Pedometers – use of a device to measure how far you have walked.
 Walking and cycling schemes

18. REFERENCES
 Strömberg, A . (2005). The crucial role of patient education in hear t failure.
The Europea n Journal of Hear t Failure, 7, 363–369
 Koelling, T., Johnson, M., Cody, R. & Aaronson, K. (2005). Discharge
education improves clinical outcomes in patients with chronic hear t
failure. Journal of the Americ an assoc iation, 18 , 179-1 85.
 Krumholz , H., Amatruda, J., Smith, G., Mattera, J., Roumani s, S., Radford,
M. et al. (2002). Randomized Trial of an Educati on and Suppor t
Inter ventions to prevent Readmissi on of Patients With Hear t Failure.
Journal of the Americ a n College of Cardiology, 39, 83-89.
 Kwok , T., Lee, J., Woo, J., Lee, D. & Grif fith, S. (2008). A randomized
controlled trial of a community nur se -suppor ted hospital discharge
programme in older patients with chronic hear t failure. The author journal
compilation, 17, 109-117
 Ricard, Camarda, R., Foley, L., Giver tz, M., & Cahalin, L. (2011). Case
repor t: exerc ise in a patient with acute decompe nsated hear t failure
receivin g positive inotropic therapy. Cardiopulmonar y Physic al Therapy
Journal, 22(2) , 13-1 8.
 Mår tensson, J., Strömberg, A ., Fridlund, B. & Dahlström U. (2001). Nur se -
led hear t failure clinics in Sweden. Europe an Journal of Hear t
Failure, 3, 139-144 .

19. REFERENCES
 Shearer, N., Cisar, N., Greenberg, E. ( 2007). A telephone -delivered
empowerment inter vention with patients diagnosed with hear t
failure. Hear t & Lung, 36, 159-169.
 Baker, D., Dewalt, D., Schillinger, D., Hawk , V., Ruo, B., Bibbins-
Domingo, K. et al. ( 2011). The ef fect of Progressive, Reinforcing
Telephone Education and Hear t
 Failure Symptoms. Journal of Cardiac Failure, 17, 789-
796.Domingues, F., Clausell, N., Aliti, G., Dominguez, D., Rabelo, E.
(2011). Arq Bras Caridol. Brasilien
 Lindén, C. et al. (2011). Web-based patient education for patients
with hear t failure.
 Alber t, N., Buchsbaum, R., Li, J. (2007). Randomized study of the
ef fect of video education on hear t failure healthcare
utilization, symptoms, and self -care behavior s. Patient Education
and Counseling 69, 1 29- 139.
 Krumholz, H., Amatruda, J., Smith, G., Mattera, J., Roumanis, S., Ra
dford M., Crombie, P., Vaccarino, V. (2002). Journal of the American

20. REFERENCES
 Carole Lannon, MD MPH.
 Jacqueline Dunbar-Jacob, PhD, RN, FAAN. Models for Changing
Patient Behavior: Creating successful self -care plans
 Eraker SA , Kirscht JP, Becker MH. (1984)Understanding and
improving patient compliance. Ann Intern Med, 100:258-268
 Michelle A . Dart. ( 2011). Motivational Interviewing in Nursing
Practice: Empowering the Patient

21. REFERENCES
NICE. (2006). Four commonly used methods to increase physical
activity. Retrieved from http:// publications.nice.org.uk/four-
commonly -used-methods-to-increase-physical-activity -ph2
Huber, T.P., Kurtin, P., & Seid, M. (2006). Clinical microsystem
assessment diagnostic.Retrieved from
http://www.dhcs.ca.gov/provgovpart/initiatives/nqi/Documents
/MSAssessmentFinal.pdf
Hayes, S. (2010). Brief interventions to change behaviour.
Practice Nurse, 39 (6). Retrieved from
http://web.ebscohost.com.dbgw.lis.curtin.edu.au/ehost/detail?v
id=5&hid=17&sid=8517c172-8956-48cb-b335-
ed8caca8b5dd%40sessionmgr13&bdata=JnNpdGU9ZWhvc3QtbG
l2ZQ%3d%3d#db=rzh&AN=2010612148

22. SEARCH PROCESS
 Looked at the problems in our previous presentation
-nursing knowledge
-patient knowledge
-lifestyle behaviours
 Chose lifestyle behaviours as the main focus as the other two
factors also tied into this problem
 Used university library data bases and government websites

23. COLLABORATION PROCESS
 We each were allocated a tool and applied it to behavioural
changes
 Calle and The both presented in previous presentations, Emily
will present today
 Each member did their own powerpoint slides, Emily produced
the final product