This guideline provides evidence-based recommendations for nurses in self-management support. These recommendations identify strategies and interventions that enhance an individual’s ability to manage their chronic health condition, especially involving collaboration with clients.
This guideline provides evidence-based recommendations for nurses in self-management support. These recommendations identify strategies and interventions that enhance an individual’s ability to manage their chronic health condition, especially involving collaboration with clients.
As an introduction, we’ve provided summaries of the practice recommendations from the BPG document — but we strongly encourage downloading RNAO’s official PDF.
Nurses utilize the “5 A’s” behavioural change approach of assess, advise, agree, assist and arrange, to incorporate multiple self-management strategies when supporting clients with a chronic illness to assist in improved outcomes.
Nurses establish rapport with clients and families.
Nurses screen for depression on initial assessment, at regular intervals and advocate for follow-up treatment of depression.
Nurses establish a written agenda for appointments in collaboration with the client and family, which may include:
Nurses consistently assess client’s readiness for change to help determine strategies to assist client’s readiness for change to help determine strategies to assist client with specific behaviours.
Nurses encourage clients to use health risk appraisal instruments; model use of such tools, and discuss the results of the risk assessment with them at regular follow up.
Nurses combine effective behavioural, psychosocial strategies and self-management education processes as part of delivering self-management support.
Nurses utilize the “ask-tell-ask” (also known as “Elicit- Provide-Elicit”) communication technique to ensure the client receives the information required or requested.
Nurses use the communication technique “Closing the Loop” (also known as “teach back”) to assess a client’s understanding of information.
Nurses assist clients in using information from self-monitoring techniques (e.g., glucose monitoring, home blood pressure monitoring) to manage their condition.
Nurses encourage clients to use monitoring methods (e.g., diaries, logs, personal health records) to monitor and track their health condition.
Nurses collaborate with clients to:
Nurses who are appropriately trained use motivational interviewing with their clients to allow clients to fully participate in identifying their desired behavioural changes.
Nurses teach and assist clients to use problem-solving techniques.
Nurses are aware of community self-management programs in a variety of settings, and link clients to these programs through the provision of accurate information and relevant resources.
Nurses arrange regular and sustained follow-up for clients based on the client’s preference and availability (e.g., telephone, email, regular appointments). Nurses and clients discuss and argee on the data/information that will be reviewed at each appointment.
Nurses use a variety of innovative, creative, and flexible modalities with clients when providing self management support such as:
Nurses tailor the delivery of self-management support strategies to clients’ culture, social and economic context across settings.
Nurses facilitate a collaborative practice team approach for effective self-management support.
