briefing - Patient Safety Resource...

PATIENT SKILLS PROGRAMMEFacilitator ManualModule B

1 About this Manual

This manual contains materials to support the delivery of the Patient Skills Programme. It includes: overview of the Programme standard programme for each session materials for the delivery of all Module B activities explanation of the icons and charts used in the materials

Additional materials to support the programme are materials for the delivery of all Module A activities materials for the delivery of all Module C activities participant Workbook and Handouts guide for Facilitators guide to Facilitator Training, Skills and Assessment guide to Quality Assurance guide for Programme Leads

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2 Overview of the programme

2.1 The purpose of the Patient Skills Programme

The core focus of the programme is to enable people to better manage their own health, through increasing their self confidence, increasing their skills and supporting positive changes in health related behaviour, leading to activated patients who feel in control of their health choices.

2.2 How this programme relates to wider health services

The Patient Skills Programme does not, and should not; exist in isolation from the wider health services that people use. The Health Foundation, through its Co-Creating Health programme, believes that people with long term conditions are best able to manage their own condition when: they have the necessary skills, knowledge and confidence they are being supported by clinicians proactively using self management support skills and

techniques the systems and processes of the healthcare service are designed to support self

management

3 Course structure

The Patient Skills Programme is normally run over six weeks, with a workshop a week. Each workshop consists of a series of activities, each lasting 20 minutes, which are put together to create a single session lasting 2 hours 40 minutes.

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However, the programme is designed to be adaptable, and may, for example, be spread over longer by running (particularly the last two or three sessions) at fortnightly, rather than weekly, intervals, or by creating new workshops.

2.4 Course delivery: co-facilitation

What makes the programme unique is that it is co-delivered by a health professional and a person with experience of living with a long term condition working in partnership. This collaboration between the professional and lay tutors is a model for the collaborative relationship the programme is promoting between health professionals and patients.

Feedback from previous participants has shown that they find the different perspectives, experience, knowledge and skills that the tutors from different backgrounds bring extremely valuable.

2.5 Course content

The programme is made up of three sets (Modules) of activities, containing a range of different components and activities:

Module A: Core Repeated Activities: Goal-setting, Goal Follow-up and Problem solving – These activities are core to health related behaviour change and should be included

and repeated in every workshop.

Module B: Core Generic Self-management skills– These activities are also considered core self management activities or core to the

group process. Each activity should be covered at least once in the course of Patient Skills Programme.

Module C: Optional Self-management skills and topics– These activities are optional and may be included as needed. Additional module 3

activities may be created for specific diseases and communities.

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3 Standard programme

All the modules are designed to be delivered flexibly, in the order and at the pace that best suits the group, however, we have set out below a standard programme for each of the six workshops.

Programme for workshop 1Module Activity Time

(minutes)B B1 Getting to know one another 40B B2 Understanding self-management 20B B3 Recognising and accepting change 20A A1 Introducing goal-setting 40A A2 Setting the agenda and close


(minutes)Welcome 5

A A3 Follow-up 30B B4 Challenging unhelpful beliefs 20C C1 Helpful breathing (optional) 20A A4 Sharing and agreeing agenda 20A A5 Working on a self-management goal 30A A2 Setting the agenda and Close 10

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(minutes)Welcome

A A3 Follow-up 30B B5 Working together in partnership 20A A6 Problem-solving 20C C2 Eating Well (optional) 20A A7 Weekly goal setting 30A A2 Setting the agenda and close 10


(minutes)Welcome

A A3 Follow-up 30B B6 What happens next? Follow-up options 20B B7 Anxiety, relaxation and your health condition 20C C3 Managing fatigue, helpful rest and sleep(optional) 20A A7 Weekly goal setting 30A A2 Setting the agenda and close 10


(minutes)Welcome

A A3 Follow-up 30B B8 Planning 20B B9 Communicating our needs and feelings 20C C4 Being thankful for what’s going well (optional) 20A A7 Weekly goal setting 30A A2 Setting the agenda and close 10


(minutes)Welcome

A A3 Follow-up 30B B10 Becoming a resourceful self-manager 20B B11 Recognising and managing set-backs 20C C10 Accepting and asking for support from others 20

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(optional)A A8 Setting Longer term goals 30

Close and evaluation 10

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4 Using the Module C Activities

Module C contains a library of optional activities which may be generic or condition-specific. There is time allocated in each workshop, with the exception of Workshop 1, for one or two of these activities to be included. At the end of workshops 1-5 there is an opportunity for the participants and facilitators to negotiate the agenda for the next workshop. Further condition-specific activities may be developed by individual organisations delivering the programme. These can be added to the Module Three library.

This list of the Module Three options and a brief description can be used by facilitators to help them during this Agenda-setting process.

Module C OptionsActivity Name Activity Description

Fatigue, rest and sleep Helps us to recognise and identify ways that fatigue can be managed by effective planning, rest, relaxation and sleep.

Eating well-making choices, making changes

Allows us to identify some small changes in the food and drink choices we make and to consider and find solutions to the barriers to making these changes.

Helpful breathing Introduces and practices helpful breathing and explains how it may help to regain control of symptoms and reduce anxiety.

Mixed feelings about being active

Explore our own ideas about the importance and benefits to us of becoming more active and allows us to consider our own mixed feelings about it.

Acknowledging and managing unhelpful emotions

Recognises and acknowledges that negative emotions (fear, anxiety, worry, and guilt) frequently accompany a health condition, reflects on your experience and to consider ways that these emotions can be handled positively.

Making a self-care plan in partnership

Introduce the Care-planning process which can be done with a member of the health care team and considers how it is being introduced locally. NB check local relevance.

Making and sharing plans for future health care

Considers the subject of planning for future, when we may be more unwell and unable to make our own decisions, and how to communicate these plans with family, friends and the health care team.

Using our minds as a self-management tool

Introduce the concept of the mind as a self-management tool, the mind body connection and some helpful techniques to manage symptoms leading to more optimal self-management.

Being Thankful for what’s going well

Enables us to feel less anxious and more relaxed by allowing us the opportunity to show gratitude for, and share with others simple events and experiences which have made us feel good.

Accepting and asking for help and support from

Explores reasons why asking for help can be difficult and considers ways to access varying types of support from family,

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others friends and colleagues.

5 Layout of the materials

Scripted and Unscripted Facilitator Instructions There are two pages which cover exactly the same workshop content:

Upper page provides structured but unscripted notes which an experienced facilitator can use to deliver the programme content. The clouds which can provide suggestions for free-thinks and discussions can be completed by facilitator beforehand

Lower page provides structured and scripted text which an inexperienced facilitator can use to deliver the programme content. The clouds which offer suggestions for free-thinks and discussions are provided.

It is expected that, over time and with greater experience, facilitators will confidently move from a scripted to an unscripted delivery style. When a facilitator uses the unscripted notes they should take care to ensure that the materials are delivered in a suitably non-directive style with careful attention to the use of language which supports self-determination.

Fonts The activities for each workshop use Arial 11 black, this is chosen as it is clear and easy on

the eyes. Comic Sans 13 Blue is used to identify discussions as it denotes a more informal

tone.

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PS

6 Guide to IconsIcons are used throughout this manual as a visual reminder to facilitators and to back-up the Facilitator Instructions

Icon Name Icon What it meansSelf-Management Circles When the Optimal Self-management circles are shown, the facilitator

should refer to the fact that self-management requires attention to all three areas of the Bio-psychosocial model of health.

Small Group Discussion This should be for groups of three or four individuals. The facilitators can and should circulate amongst the small groups to offer support and clarification.

Whole Group Discussion This is an opportunity to discuss issues as a whole group. There are open questions in the notes which can be used to stimulate the discussion. However these may or may not be required. There are also ideas in the clouds which may be helpful to guide the discussion. If any discussion becomes negatively focussed the facilitator should initiate a problem-solving approach and ensure that solutions are identified before the discussion ends.

Problem Solving Opportunities for problem-solving occur throughout the workshops; during Goal-setting, Goal Follow-up and during individual activities. Any opportunity to problem-solve should be seized when time allows. Problem-solving can use either a formal process where ideas are captured on a flip-chart, or an informal process where the facilitator verbally collects ideas from the group and offers them back to the participant who voiced the problem to enable them to choose a solution which is helpful to them.

Pair and Share This is an opportunity for individuals to briefly ‘pair-up’ with another participant, so they can share their experiences safely. Should there be an uneven number of participants, it works best if one of the facilitators makes up a pair. Do not allow these ‘pair and share’ conversations to last more than 2 or 3 minutes.

Freethinking It can be helpful to head the Group free-think chart beforehand. Both facilitators are involved in a free-think, one acts as a scribe whilst the other generates and manages the ideas from the group and feeds them to the scribe at a pace they can write. Ask the questions and allow the group time to come up with their ideas. Be prepared to rephrase the question if you feel this will help the group to generate more ideas. The clouds provide other ideas. With permission from the group you could add a few of these if they are finding it difficult. Scribe the ideas from the group, using the words of the participant. If the idea is rather long-winded, ask “How would you like me to write this down?”

Role Modelling Box There are many opportunities to role-model your own experience of self-management. Prepare these beforehand and identify examples which will be relevant and helpful to the group, and which you feel comfortable to share. When talking about your own experience you should be brief, approximately 30 seconds, and always finish by describing the solution which worked for you.

Role Play During a role-play, both facilitators act out a short interaction between two people. Briefly explain beforehand that this is what you are doing. It can be useful to tell the group when you are starting the role-play and again when the role-play has stopped.

Refer to / complete Workbook

In many activities reference is made to completion of materials which is in the work book that accompanies the workshops. Some of these, like Goal-setting, are for completion during the session; others are for use at home, like Guided Imagery, whilst others are for reference only.

7 Guide to Charts

These Charts are used through the workshops.

Self-management circles

Group Ground-rulesWe agree to:

treat each other with respect arrive in good time and aim to attend every session let everyone’s viewpoint be heard maintain confidentiality identify achievable goals and work towards them help others find solutions to problems they encounter join in discussions gather and share information and resources with others be open-minded about new ideas and give them a try

Our Goal Needs To: Be our choice Be important to us Be a little difficult to achieve Allow us to feel more confident once we have achieved it Let us show other people and ourselves that we can

overcome problems Let us feel in control

Questions to help you set your Goals What is your Goal? How important is your Goal to you? What makes it important? What do you need to achieve it? Which bits will you do this week? How much? How often? When? If you visualise yourself doing this bit of your Goal this week, how

confident do you feel, on a scale of 0-10?

What am I going to this meeting for and what do I hope to get from it?Problem Solving

Identify the problem Explore it Think of some ideas Choose one to try Try the idea out in a real life situation

Identify the real problem

Explore the problem

Suggest Ideas

Choose an idea Try the

idea out

Choose another

idea

Get more ideas

Accept problem isn’t solvable now

Problem Solve

Questions Chart What am I going to this meeting for and what do I hope to get

from it? How have I been feeling since my last visit? What have I been finding difficult? What else in my life might be affecting my health? What have I been doing to look after my health? Is there anything I might find difficult to talk about? What is my goal?1. What do I need to know about treatments?

Questions to help you with Goal Follow-Up What was your goal for the past week?

How much? How often? When? Was it the whole goal or a step towards your goal you wanted to

reach? Tell us how you did with that goal?

The Journey towards Optimal Self-ManagementMy role in

managing my health

condition is important

I am confident

that I know how to

manage my health

condition

I can identify and

solve problems when they

arise

Beginning the journey x x x

Finding the Route x x

Travelling xStaying on

Track

Becoming Resourceful How else might I get what I need? Who else has information that might help me? What is something very similar which might also work? Who else has expertise in this field? What is another thing I can try? What would I suggest someone else could do in a similar

situation?

Tips for Preparing an Active Declaration Plan a meeting with doctor to discuss what you might want to

happen Choose the best person to act for you and talk about it with them Decide what you would want to happen Prepare any documents, with professional advice (e.g. GP, CAB) Sign the documents and get them witnessed Make sure right people know you have the documents Have several copies in useful places (e.g. medical notes, with

medicines)

Why is it helpful to have a setback plan? You feel you are doing something to manage the change You feel more in control To speed up recovery Helps to regain lost function Can give other people a helpful role Provides a sense of direction Provides small goals to work towards

medical

emotionalsocial

The 3 Circles Questions to help us plan How long it will take? When is the best time to do it? What help do I need to do it? Can I break it down into chunks? What do I need to do to prepare for it? What do I need to do to recover afterwards?

Materials to support activities

Module B Activity B1: Getting to know one another

Aim: create a safe, welcoming environment explain the course structure

Objectives: speak to 5 new people agree the group guidelines hear about the course structure

Activity: Introduction to the course and one another Time: 40 minutes

Requirements: Name cards, Marker Pens, Group Ground-rules Chart, Agenda Workshop 1, Prepared Modelling boxes

Number of Pages: 10

Unscripted Instructions

Facilitators need to check this information out before the programme starts.

Facilitators should model this too.

Use the box to record your experiences.

Facilitator one followed by facilitator two provides a short ONE MINUTE explanation of their experience of self-management and how they hope they will be able to share their experience.


ULE B: Core generic skills Welcome the group and go through the house keeping:

– toilets– fire alarms– finish time– refreshments– mobile phones off or on silent mode– any other issues

Remind them that this programme is about self-management and that they should take care of themselves and their health condition throughout

Ask the group to fill in their name labels/cards and introduce themselves to the people sitting either side of them

Mention the workbook on the resource table Explain your role and say why you are here

Scripted Instructions

Facilitators need to check this information out before the programme starts.

Facilitators should model this too.Use the box to record your experiences.

Each Facilitator in turn provides a short ONE MINUTE explanation of their experience of self-management and how they hope they will be able to share their experience.


It is really good to welcome you all to this first Self-Management workshop.

In a few minutes, we will be able to get to know one another a little, then after that you will be able to find out about the workshops and more about self-management of a health condition. Let’s start with some housekeeping:

– toilets– fire alarms– finish time– refreshments– mobile phones off or on silent mode– any other issues

These workshops are about Self-Management, so please do whatever you need to do to feel comfortable, and to look after your health while you are here.

Please write the name you would like to be called on your labels/name cards. While you are doing this please also introduce yourself to the people sitting either side of you. There is a workbook which accompanies this programme - please take one from the resource table during the break.

Now we’d like to tell you a little bit about ourselves and why we are here to facilitate these workshops.


Talk a little about Self-Management making sure you acknowledge that they are already managing their life with their condition to some extent. You can make your own notes, using the scripted version to help.

Ask the group to introduce themselves to 3 new people, by holding a short conversation to find out:– Their name– Their health condition(s)– An everyday problem of living with their health condition– Something they are already doing to take care of their health


Allow no more than 10 minutes for this. Move round the room facilitating this activity.


The idea of self-management might seem new to you now, but, whether we call it that or not, we all self-manage every day. We make decisions about what we eat, how much we exercise and rest and whether or not to take our medication. These workshops are not about telling you what to do; instead they are about finding out some information, learning from each other, and finding some new solutions to the everyday problems that life with a health condition brings.

We all have choices in how we manage life with a health condition. We can:

Carry on living the same way as before we had the condition, make no changes, ignore it and the advice of health professionals. In this case our condition gets worse and we may become more disabled.

Constantly worry about the condition and allow it to control every aspect of our life. In this case we are likely to become frustrated, anxious, depressed and even defined by our condition.

Another way is to accept the changes that are brought about by the health condition, make helpful adaptations in the way we live and enable family, friends, health professionals and colleagues to support us. In this way we are in control – the condition is a part of us not us a part of the condition. This is what these workshops are all about.

In these workshops you will find out how to accept the changes we need to make and learn from others about the adaptations they have made. We have all found things that did and did not work for us and this group allows us all to benefit from each other’s experiences.

To help us to get to know one another we will now do a short exercise. We would like you to speak to three new people in the room. Please find out:

Their name Their health condition(s) An everyday problem of living with their health condition Something they are already doing to take care of their health


Allow no more than 10 minutes for this. Move round the room facilitating this activity.


Stimulate a group discussion, using the suggested questions below:

What have you learnt from sharing these things with other people? What problems seem to be common to many people? What things are people already doing to manage their health?

Go through the suggested group ground rules chart, asking if there is anything they would like to add and agree to:

We would now like to have a group discussion around some of the things we’ve learned from these brief conversations.

Unscripted InstructionsBring the group back together. Spend about 5 minutes discussing their findings. The intention here is for the group to bond by recognising the common problems they share.

Get the group’s agreement and display this chart in a prominent position during every workshop. It can be a useful tool when managing challenging situations.




What have you learnt from sharing these things with other people? What problems seem to be common to many people? What things are people already doing to manage their health? We have seen that although we may live with different health conditions, some of the

feelings we have and the problems we encounter are common. Despite the challenges we experience, most of us have already taken some positive steps to manage our health, such as coming here today. Living with a health condition can be challenging - these workshops help us to identify and meet these challenges in a positive way.

To help us get the most out of our time together, we have some suggested group ground rules.

Is there anything you would like to add to this list?




Bring the group back together. Spend about 5 minutes discussing their findings. The intention here is for the group to bond by recognising the common problems they share.

Get the group’s agreement and display this chart in a prominent position during every workshop. It can be a useful tool when managing challenging situations.


References and Notes


Give some information about the structure of the workshops. Referring to the workbook explain about:

– goal setting/follow up– core modules– optional modules

Go through the Agenda.

Agenda Workshop 11. Introduction to PSMSP and one another (40 mins)2. Understanding Self-management and what it means to you (20 mins)

BREAK (20 mins)

3. Recognising, accepting and embracing change (20 mins)4. Introducing Goal Setting (40 mins)5. Setting the Agenda for next workshop and Close (10 mins)


Guide the group through their workbooks, showing the list of core and optional modules.

Go through the agenda, pointing out that all modules are 20 minutes long apart from goal setting and goal follow up. Each workshop includes a 20 minute break.


We’d now like to explain a little about how these workshops are structured.

There are 6 workshops in total and each one lasts for a little over 21/2 hours. Today, and in every workshop, we will each set an individual goal which we can work towards over the week; we will follow-up on that goal in the following session. Goal-setting allows us to make positive changes in our lives to help us manage our health.

As well as working on our goals we will cover some core self-management skills. Each week we will agree which optional module we want to cover. There is a list of all the core modules and all optional modules in your workbooks.

The agenda for this first workshop is already planned but at the end of this session we will consider and agree together the agenda for the next workshop.

This is the agenda for this session.


Guide the group through their workbooks, showing the list of core and optional modules.

Go through the agenda, pointing out that all modules are 20 minutes long apart from goal setting and goal follow up.

Each workshop includes a 20 minute break.

Agenda Workshop 1 Introduction to PSMSP and one another (40 mins) Understanding Self-management and what it means to you (20 mins)

BREAK (20 mins)

Recognising, accepting and embracing change (20 mins) Introducing Goal Setting (40 mins) Setting the Agenda for next workshop and Close (10 mins)


Appendix, References and Notes

Module B Activity B2: Understanding Self Management and what it means to you

Activity: Understanding self management and what it means to you

Time: 20 minutes

Requirements: Self management circles chart, Prepared modelling boxesFlipchart: what are some things we may need to manage to stay well?

No of pages: 8

Aim: To show participants that Self-Management is more than the medical management of their condition.

Objectives: been introduced to the three areas of the bio-psychosocial model have related the bio-psychosocial model to their own lives considered what Self-Management means to them in their daily lives


medical

emotionalsocial

The 3 Circles


Introduce the idea that everybody in the room shares something in common – a health condition which effects everyday life

self-management allows us to re-gain some control in our lives as a group we can learn some skills and support each other to make positive changes introduce the Self-Management Circles chart to explain the bio-psychosocial model of health


medical

emotionalsocial

The 3 Circles


In the introduction we saw that all of us live with a health condition that we didn’t ask for or expect; it affects us day-to-day and we know that it cannot be cured with a magic wand. We also shared with other people something that we are already doing to look after our health. Coming here today and joining this group is a positive step towards gaining more control over the management of our health condition.

The core focus of this self-management programme is to allow you to see and to practise some skills that will increase your confidence to deal with the ups and downs of life with a health condition. Each workshop will help you to become a more activated self-manager and support you to take some positive steps in taking care of your health.

What do we mean by self-management? It is more than the medical management of a health condition; it is about managing the impact your health condition has on your life and managing the impact your life has on your health condition.


Point to the biological circle.

Point to the emotional circle.

Point to the social circle.

Prepare these in advance. This should be modelled by someone living with a health condition – i.e. a lived experience.


Explain that Self-Management is more than the medical management of the health condition and involves:

– Having a useful understanding of our health condition, how it affects us and the steps we can take to take care of it. This might include things like taking medicine, doing exercises and making healthy food choices.

– Recognising and acknowledging that our health condition has an effect on our emotions and how we feel. For many of us our emotions can also affect our health condition, so it works both ways.

– Acknowledging that we may need to make changes in the daily activities we carry out or are involved in can also help. This might include our work, our social life or even just how we shop or mow the lawn.

Give a personal medical example.

Give a personal emotional example.

Give a personal social example.


Point to the biological circle.

Point to the emotional circle.

Point to the social circle.

Prepare these in advance. This should be modelled by someone living with a health condition – i.e. lived experience.


What can we do to self-manage well?

It helps if we have a useful understanding of our health condition, how it affects us and the steps we can take to take care of it. This might include things like taking medicine, doing exercises and making healthy food choices.

It can help if we recognise and acknowledge that our health condition has an effect on our emotions and how we feel. For many of us our emotions can also affect our health condition, so it works both ways. If we are aware of this connection we can work at reducing this impact.

Acknowledging that we may need to make changes in the daily activities we carry out or are involved in can also help. This might include our work, our social life or even just how we shop or mow the lawn. Whilst it is important to take care of the biological aspects of the health condition, we also need to take care of our emotional and social needs too.

In my case:

Give a personal medical example.

Give a personal emotional example.

Give a personal social example.


offer an explanation of the medical circle when explaining the emotional circle, ensure you mention unhelpful health beliefs when explaining the social circle, you can give a personal example here mention that everyday life also happens

Explain freethinking:– Direct ideas to the board.– All ideas are valuable.– No discussion.

What are some things we may need to manage to stay well?


Instructions: When showing this chart make sure you have thought about the three areas in your own life and model this.

Head up the freethink chart in advance.


When we think of the red biological or medical circle it can include things like taking medication, changing our behaviour by making more healthy choices about what we eat and whether or not to exercise. It can also include resting and recuperation.

Being diagnosed with a health condition naturally affects how we feel. We may have many unhelpful health beliefs and so might our family and friends. Sometimes health professionals can also have unhelpful health beliefs. How we feel and what we believe has a real impact on our condition. This is the green emotional circle.

The blue or social circle is about adapting the things we do day-to-day. This might mean using a walking stick or a wheelchair sometimes, using a stool in the shower, or we might need to shop in a different way, change the way we dress or wear different shoes. These changes may happen slowly or come upon us suddenly. To get the most out of life we need to be willing and able to make positive changes.

On top of all of this there are the everyday things in life that we don’t have control over – they just happen.We are now going to have a freethink. Freethinking is a way of generating a lot of ideas quickly. For it to work well there are some guidelines we need to follow: direct all ideas to the board all ideas are valuable no discussion while ideas are flowing, please What are some things we may need to manage to stay well?


When showing this chart make sure you have thought about the three areas in your own life and model this.

Head up the freethink beforehand.

Diet, exercise, medication, housework, relationships, work,

social activity, frustrations, stress, fears, shopping.


Using the freethink list generated, ask participants to work in small groups of 3 or 4 maybe with somebody new.

As participants to look at the three circles in their workbooks and put activities relevant to their own circumstance into one of the coloured circles

After about 5 minutes bring the group back together and have a whole group discussion

What did you discover during your small group discussions? Did you think of any new ideas?

Effective Self-Management in our everyday life, acknowledge that juggling life with a health condition can feel like hard work at times


Leave the list just generated on display.Allow 5 mins in small groups to discuss.

Follow up with a whole group discussion making sure they recognise that the circles on the chart overlap. Some things fit into more than one circle.

Do not add things to the freethink list.


In small groups of 3 or 4, and using your workbooks, we now want you to think about your own life, and your health condition. Have a discussion about the things on the list. Which of the three areas / circles would you put them in? Use the things which are particularly relevant to your own lives. You might also come up with some new

ideas as you do this. Now might be a good time to work with somebody you haven’t spoken to yet. We will give you about 5 minutes and then bring everybody back together to think about what we noticed.

What did you discover during your small group discussions? Did you think of any new ideas?

The circles overlap and interact. Self-Management is about considering all three circles at the same time and how they fit with your everyday life. While we are managing the impact

our health condition has on our lives, we also need to carry on with the day-to-day things like looking after our house, our families and work. Living with a health condition is not just about looking after the medical area of the health condition. Achieving optimal self-management is about ensuring that we look after all three areas of our health and carry on with our everyday lives too.

You can see then from the chart that effective, optimal Self-Management happens when we are looking after all three circles at the same time and carrying on with everyday life. There will be happy times and times which can be challenging and frustrating – Self-management is about having a holistic approach to living with our condition(s).

Managing life with a health condition can feel like hard work at times - it takes time and practice. This programme is about becoming an activated self-manager; learning some skills so that we can become better at juggling our lives with a health condition.


Leave the list just generated on display.Explain that there are blank circles in their workbooks or they could jot things down on paper. Allow 5 mins in small groups to discuss.

The purpose really is to show that everyday life is complicated, and that some things may overlap.

Follow up with a whole group discussion making sure they recognise that the circles overlap. Some things fit into more than one circle. Do not add things to the freethink list.

Module B Activity B3: Recognising and accepting change

Aim: To introduce and explore the concept that self-management of a health condition requires a readiness and willingness to accept and embrace the

need for behaviour change.

Objectives: consider how change feels and why we resist it recognise that change has already happened and that it requires a modification in everyday behaviour in order to adapt identify where they are on this journey of change understand that the workshops are about facing up to the need to adapt to change

Activity: Recognising, accepting and embracing change

Time: 20 minutes

Requirements: Patient Journey Chart, Self-Management Circles Chart, Prepare Modelling Boxes

Number of Pages: 10




Talk about how being diagnosed with a health condition changes us we may not want to change and may not like the changes we need to make change is uncomfortable

What changes in your life had you already experienced by then? How did those changes make you feel? Why do we find change so hard?

Talk about feelings at diagnosis Think about being passive, things are being done to us, we feel we have no control



Living with a health condition involves change. It is a change we didn’t want or ask for. The health condition may have arrived unannounced and although we do not want it, we are stuck with it.Our life changes because of the health condition; perhaps we have pain when we had none before, or we may feel short of breath, or much more tired. In addition, we may also need to make changes in the way we live our everyday lives to help us to limit the damage done to our bodies by the health condition. We may have been told to take tablets, to do things we have never enjoyed like walking or to stop doing things we have always enjoyed like eating cake (or walking).

Most of us don’t really like change. Change makes us feel uncomfortable, anxious and perhaps even angry at times. Think back to a time before you had your health condition.

What changes in your life had you already experienced by then? How did those changes make you feel? Why do we find change so hard?

When we are first diagnosed with a health condition we might have felt shocked, angry or sad. We may have had to have frequent medical meetings and tests. It may have taken time for us to be given a medical diagnosis and even longer to come to terms with this new diagnosis. Perhaps we felt rather like a passenger on a bus, not in control of where we were going. All these changes and new experiences can lead to us feeling less confident.

Leaving home, going to college, changing

schools, jobs.


One facilitator asks the other the 2 questions.

Model a change caused by your health condition eg loss of mobility, breathlessness, pain.

Model something you have done to help you to adapt to life with the condition eg. Pacing, using a wheel chair for shopping, relaxation.

Allow 5 minutes for this table-discussion and then ask for brief feedback.

Some people may have found this discussion distressing; facilitators need to be aware and to offer empathic support.


talk about adapting to change, some of us do it naturally, sometimes it takes real effort

Co-Facilitator asks “What change has been brought about by your health condition?”

Co-Facilitator asks “How have you adapted to this change?”

ask the group to think about how their health condition has affected their life and any changes they have had to make

do this in small groups and ask for brief feedback



Model a change caused by your health condition eg loss


We have seen that most of us have experienced change; it is part of everyday life. When change happens we may feel uncomfortable and that the situation we are in is out of our control for a while. When we adapt to the change it involves us taking steps to regain some of the control that we lost. Sometimes we adapt naturally; sometimes we have to make a real effort.

Co-Facilitator asks “What change has been brought about by your health condition?”

Co-Facilitator asks “How have you adapted to this change?”

We would like you to think about a change which your health condition has made to your life... In a minute we will ask you to share with others on your table about the biggest change which has been brought about by your condition.



Model a change caused by your health condition eg loss


acknowledge this may have felt difficult, change is uncomfortable part of self-management is accepting change we can have an active role in managing our lives with a health condition introduce chart of the Journey Towards Optimal Self-Management


Patient facilitator models a brief description of their journey towards optimal self-management.

The Journey towards Optimal Self-ManagementMy role in managing my health condition

is important

I am confident that I know how to manage my health condition

I can identify and solve problems when they arise


Finding the Route x xTravelling x

Staying on Track


Some people may have found this difficult, other people may have found focussing on the changes quite painful. We have said that change feels uncomfortable for most of us.Part of self-management involves accepting that life has changed, and, that it will continue to do so. By accepting that change is an inevitable part of life with a health condition we can begin to take a more active role. Rather than being a passenger on the bus we can start driving it ourselves. If we see our role in managing our health as important then we can gradually begin to feel more confident to work in partnership with health professionals, to make helpful choices and to solve the problems we encounter on the way. We can see this on the chart.If we see our role in managing our health as important then we can gradually begin to feel more confident to work in partnership with health professionals, to make helpful choices and to solve the problems we encounter on the way.


Use the chart to explain:

Patient facilitator models a brief description of their journey towards optimal self-management.

The Journey towards Optimal Self-ManagementMy role in managing my health condition

is important

I am confident that I know how to manage my health condition

I can identify and solve problems when they arise


Finding the Route x xTravelling x

Staying on Track


Where do you feel you are on this journey? Where would you like to be?

These workshops are about becoming more activated self-managers. Even people who are staying on track are still learning about self-management


Ask the group to look in their workbooks and make a note of where they are now on the patient journey.


Where do you feel you are on this journey? Where would you like to be?

These Self-Management workshops are about change; about accepting the importance of the role we play in managing our health condition and about trying out new skills which will increase our confidence. We will be able to face up to these changes and find different ways which work for us; perhaps to adapt, in the same way as (co-facilitator) talked about doing. For somebody who is staying on track, there are always things to learn.

Make a note in your workbooks of where you think you are now on the Patient Journey.


Ask the group to look in their workbooks and make a note of where they are now on the patient journey.

Module B Activity B4: Challenging unhelpful beliefs

Aim: To enable participants to identify beliefs and ideas they and people around them may have about their condition and the importance of

accurate information about their condition.

Objectives: Consider the role unhelpful beliefs have in increasing disability. Identify ideas and beliefs they may have about their condition. Reflect on how their own beliefs, and those of people close to them, may affect them and the choices they make. Identify sources of correct information.

Activity: Challenging Unhelpful Beliefs Time: 20 minutes

Requirements: None

Number of Pages: 8


Make sure you understand these examples.

It may help if facilitator one plays first role and facilitator two the second role.

The prompt questions are there as a guide. You can use these, or any other appropriate questions, to stimulate the discussion.


explain about the significant role personal beliefs play in the way a health condition is self-managed

suggest that the thoughts and beliefs of other people can also have an impact on self-management behaviour

Invite the group to listen to the following two situations:

Jim lives with angina. He believes that when he feels the pain of angina that this is similar to a mini heart attack and is causing damage to his heart, so he avoids any activity or exertion that

may trigger his angina. This reluctance to exercise leads to his heart becoming more out of condition, and leads to a worsening of his angina and means he can do less and less before the pain is triggered.

Or;

Bob lives with exactly the same degree of angina but he believes and knows that angina is not a heart attack and exercise won’t damage his heart. He also knows that any exercise he does will improve the blood flow to his heart and so he gradually increases the amount of exercise and activity he does and over time he can do more and more before the angina pain is triggered.

What are your thoughts about these two situations? Who is likely to feel more disabled by his angina?


Make sure you understand these examples.

It may help if facilitator one plays first role and facilitator two the second role.



The way we think about our health condition and what we believe about the things we can and can’t do has a great effect on us and the way we behave. The way other people think and behave around us also affects us. Sometimes we don’t even realise this is happening.We can think about how this may work now.

Jim lives with angina. He believes that when he feels the pain of angina that this is similar to a mini heart attack and is causing damage to his heart, so he avoids any activity or exertion that may trigger his angina. This reluctance to exercise leads to his heart becoming more out of condition, and leads to a worsening of his angina and means he can do less and less before the pain is triggered.

Bob lives with exactly the same degree of angina but he believes and knows that angina is not a heart attack and so exercise won’t damage his heart. He also knows that any exercise he does will improve the blood flow to his heart and so he gradually increases the amount of exercise and activity he does and over time he can do more and more before the angina pain is triggered.

What are your thoughts about these two situations? Who is likely to feel more disabled by his angina?


One facilitator models an example of an unhelpful belief they have had about their condition (or of one someone else close to them has.) Describe briefly how it may have affected you.


Complete this cloud with suitable condition-specific examples.


explain that unhelpful health beliefs can affect the choices we make and the way we behave

What unhelpful beliefs have you had about your own condition in the past? What beliefs have you heard from other people? What have you seen or read which may be unhelpful? How did these beliefs affect you?


One facilitator models an example of an unhelpful belief they have had about their condition (or of one someone else close to them has.) Describe briefly how it may have affected you.

The prompt questions are there as a guide. You can use these, or any other appropriate questions to stimulate the discussion.


These unhelpful beliefs can have a powerful effect on the way we behave and the choices we make.

What unhelpful beliefs have you had about your own condition in the past? What beliefs have you heard from other people? What have you seen or read which may be unhelpful? How did these beliefs affect you?

I feel OK so my blood pressure/blood sugar can’t be high. You need to pull yourself

together.Pain/breathlessness is my body’s way of

making me stop. If I rest more, it will get better. Exercise makes me worse. I’ll wait until I get

really bad before I do anything. If I keep taking tablets they’ll stop working.

I feel OK so I don’t need to go for a check-up.


Allow the group time to come up with their ideas. Be prepared to rephrase the question if you feel this will help the group to generate more ideas.

With permission from the group you could add a few ideas from this list if they are finding it difficult.

Make sure there is reliable information available.


describe some of the ways that these unhelpful beliefs are developed and give examples of where they might come from

explain that we need to check out our knowledge and understanding to make sure we have the correct facts

Where might we find these trusted sources of information?

Inform the group that there are useful sources of information in their resource pack Invite the group to consider their own health beliefs over the next week and suggest they may

consider this as a goal they wish to set for themselves



With permission from the group you could add a few ideas from this list if they are finding it difficult.

Make sure there is reliable information available.


Unhelpful beliefs come from many different places. They might come from magazines, friends, family members or the internet. We may not even know where these ideas originate; they can be rather like old wives tales which we take as truth. Medical knowledge is constantly developing too, so what was thought to be true in the past may not be so now. In the 1950s people believed that smoking cigarettes was good for them, very few people would believe this now.We cannot just assume that what we believe, or what other people tell us, is correct. We need to be able to check our facts and use trusted sources of information.

Where might we find these trusted sources of information?

There is more information in your resource pack about sources of reliable information.Over the next week you may want to spend some time thinking about what you know about your health condition and identify a source of reliable information, you may even want to make this your goal for the week.

Information prescriptions, NHS Choices website, Societies-Diabetes UK, MS Society, British Heart Foundation,

Pharmacist, Some websites, Health Education Department

Module B Activity B5: Working together in partnership

Activity: Working together in partnership

Time: 20 minutes

Requirements: Flipchart, Agenda Setting Questions chart

Pages: 8

Aim: To provide information and an opportunity to explore the importance of the patient and clinician partnership when self- managing a health

condition and to increase confidence to communicate effectively with health care team.

Objectives: recognise the importance of equal partnership between patient and clinician consider their role in this partnership and how they can contribute reflect on some situations where communication between patient and clinician does not work and consider ways to improve this



The prompt questions are there as a guide. You can use


introduce the idea that when a patient and a clinician work together in equal partnership it can lead to an improvement in health

acknowledge that sometimes this partnership between clinician and patient is not there and that sometimes problems occur

How have you found your meetings with health professionals? How helpful are they? Why do we find it easier to work with some professionals than with others? Are there things we can do to help us get the most out of our meetings?

Suggest that both the patient and the clinician can take steps to improve this partnership. – this course and a similar one for clinicians are positive steps

Most of us, who live with a health condition which affects our everyday lives, only see a member of the health care team a few times a year. So, working together with the health care team on those occasions is an important way


The prompt questions are there as a guide. You can use


to make sure our health is managed as well as it can be. In those meeting, you are partners – the clinician brings the medical knowledge and you, the patient, bring the experience of living daily life with the condition.

For many people this partnership is a helpful one which contributes positively to the way they self-manage their condition, however, not everyone feels this way all the time.

How have you found your meetings with health professionals? How helpful are they? Why do we find it easier to work with some professionals than with others? Are there things we can do to help us get the most out of our meetings?

There are many things a clinician can do to improve the way these meetings go, some of them may even be attending training to help them, and there are things we can do too.

Let’s think about this more now.



What can we do to get the most from our meetings with health professionals?

summarise these ideas as ways to self-manage more effectively Suggest that it may be helpful to prepare for meetings with health professionals by asking yourself

the following questions:

Agenda Setting Questions What am I going to this meeting for and what do I hope to get from

it? How have I been feeling since my last visit? What have I been finding difficult? What else in my life might be affecting my health? What have I been doing to look after my health? Is there anything I might find difficult to talk about? What is my goal? What do I need to know about treatments?


It can be helpful to head the Group free-think chart beforehand.


The coloured box provides other ideas. With permission from the group you could add a few of these if they are finding it difficult.

Draw attention to this chart by pointing out the questions or asking for more ideas.

Invite the group to discuss the questions.Explain that this list is in their workbook.


What can we do to get the most from our meetings with health professionals?

Any meeting with a health professional should be useful to us both, it should help them to do their job better and it should help us to self-manage better. If we prepare well and share our hopes for the meeting with the clinician we can together set an agenda which lets us make the most of the time we have.To help us to prepare there are some questions we might want to ask ourselves before our meeting with a health professional.

Agenda Setting Questions What am I going to this meeting for and what do I hope to get from

it? How have I been feeling since my last visit? What have I been finding difficult? What else in my life might be affecting my health? What have I been doing to look after my health? Is there anything I might find difficult to talk about? What is my goal? What do I need to know about treatments?

Arrange appointment at a time which works for us, Think and write down what we want to cover, Talk to someone about what we hope to get from the meeting,

Take someone along, Share our hopes for the meeting with the clinician, Clarify what

will happen next, what we need to do.


Ask the group to identify some situations that they have found difficult in the past.You may want to note down some ideas of your own.

Invite the group to come up with some solutions to these problems.The facilitator not leading this activity can jot down the ideas and summarise these.


invite the group to share some difficult situations when seeing a health professional

What type of situations might feel awkward?

So what can we do if these situations arise?

Suggest that preparing a suitable phrase in advance can help - invite the group to suggest some phrases or suggest one yourself, eg “There is something I feel awkward talking about”.

Suggest that it can be helpful to reflect on how the meeting went, perhaps with friend or family member.

Acknowledge that health professionals sometimes have bad days. Suggest that by giving the right information and being honest about their behaviour can help the

health professional treat them more effectively.


Ask the group to identify some situations that they have found difficult in the past.

Invite the group to come up with some solutions to these problems.The co-facilitator can jot down the ideas and summarise these.


Even if we prepare well before we go there are some situations which most of us would find difficult. What type of situations might feel awkward?

Many people will have experienced similar problems to these.

So what can we do if these situations arise?

There are many different ways to manage these situations but people have told us that having a ready-made phrase can be quite helpful. I might say “There is something I feel awkward talking about”, or “I know what you have to say is important but I find it a lot to take in.”

Afterwards it might be good to think about how the meeting went, perhaps with a friend or family-member. Perhaps we could ask ourselves: Did I get what I needed from this visit? What would I do differently next time?

It can be helpful to remember that sometimes health professionals have difficult days too, and that they depend on us giving them the right information and being honest about how we feel about the treatment they offer.

We don’t really understand what the clinician is saying. The clinician tells us

to do something we will find too difficult to do

We feel awkward to talk about a

Module B Activity B7: Anxiety, relaxation and our health condition

Aim: To introduce support and activities that may be available post PSMSP and to enable participants to think about organising their own PSMSP

group.

Objectives: reflect on their own support needs identify support available post PSMSP consider the idea of setting up ongoing Self-Management support

Activity: What happens next? Follow up Options.

Time: 20 minutes

Requirements: Information about local options for follow-on.

Number of Pages: 2

Unscripted

There will be considerable variation in this activity according to local setting and requirements so this activity is unscripted.

You will need to be aware of and have been provided with information about local options for follow-on.

You may want to consider inviting a former PSMSP participant who is now part of an ongoing follow-up group to share their experience.

Module B Activity B6: What happens next? Follow-up options

Remind the group these workshops last for 6 weeks .What support do you receive from the PSMSP? Where might you receive this support once the PSMSP is finished? How confident do you feel that you can continue to work towards your goals once the workshops finish?

Explain that this is an opportunity to consider their ideas and preferences for continuing this support after the PSMSP ends.

If you were to continue to receive support from a group like this, how would you want it to look? Would it be as a small or larger group? How often? How long? Where? Would it be structured or unstructured? Would you want speakers or more informal discussion?

share with group what is available locally establish how many people would want to continue with follow-up meetings suggest that they may want to discuss in the break and we will revisit on the last workshop

Module B Activity B7: Anxiety, relaxation and our health condition

Aim: To identify feelings of anxiety and ways of managing anxiety.

Objectives: normalise feelings of anxiety and consider how these feelings impact on our health condition identify some situations which make us feel anxious and increase our symptoms identify ways to manage anxiety consider relaxation as one method of managing anxiety practise a relaxation activity

Activity: Anxiety, relaxation and our health condition.

Time: 20 minutes

Requirements: F/T What ways have you found helpful to manage feelings of anxiety?

Number of Pages: 10


Use the self-management circles to show how our body, our mind and our everyday lives are connected.

The prompt questions are there as a guide. You can use these, or any other appropriate questions, to stimulate the discussion.Always mention this caution:Although our chest may feel tight when we are anxious, this should not feel painful. Severe chest pain is not a symptom of anxiety.

acknowledge that feelings of anxiety are common and most of us have experienced these at times explain that stress and anxiety can make any symptoms we are experiencing feel worse briefly describe the stress response explain that feelings of anxiety can come on rapidly or can build over times give some examples they may be familiar with discuss with the group how this made them feel

What sort of situations have led you to be aware of feeling stressed? How did the anxiety make your body feel?


Use the self-management circles to show how our body, our mind and our everyday lives are connected.

The prompt questions are there as a guide. You can use these, or any other appropriate questions, to stimulate the discussion.Always mention this caution:Although our chest may feel tight when we are anxious, this should not feel painful. Severe chest pain is not a symptom of anxiety.

Most of us have felt anxious at some time in the past; these feelings are a normal part of everyday life. Living with a health condition can increase these anxious feelings for some people and these feelings can have an effect on our health condition and make any symptoms we have feel worse.

When we are in a stressful situation our bodies release adrenalin, a hormone, which creates the feelings of anxiety - galloping heart, tense muscles, a tightness in the chest. These feelings can sometimes seem just like some of the health symptoms we experience. Sometimes feelings of anxiety happen suddenly, perhaps if we are late for an appointment and stuck in traffic. At other times anxiety builds gradually over a longer time, perhaps if we are worried about a medical procedure.

What sort of situations have led you to be aware of feeling stressed? How did the anxiety make your body feel?

Sweaty palms, Tremor, Tight chest, Difficulty getting words out,

Diarrhoea, Palpitations, Butterflies in stomach, Dry mouth.

What ways have you found helpful to manage feelings of anxiety?

summarise by reminding group there are many different ways to manage anxious feelings explain that when we relax we breathe in a different way, from lower down in our chest, and that

deliberately breathing in a different way can help us to relax explain that relaxation reduces anxiety which in turn reduces the symptoms we experience


Allow group time to come up with their ideas. Be prepared to rephrase question if you feel this will help the group to generate more ideas.With permission from group you could add a few ideas if they are finding it difficult.

What ways have you found helpful to manage feelings of anxiety

We can see that there are many ways we can manage our anxiety; the method we choose will depend upon the circumstances and situation we are in.

When we are relaxed our breath comes from lower down in our chest. By deliberately changing the way we breathe we can feel more relaxed, our body makes less adrenalin and more of the hormones that make us feel calm. A simple breathing technique like pursed lip breathing can be helpful in any situation. Relaxation can make a real difference to feelings of anxiety. Feeling less anxious can reduce the symptoms we experience. Even if we don’t feel anxious, using relaxation has been shown to improve our feeling of well-being. This sort of relaxation is different from watching TV or reading.

Correct information, Deal with issue causing anxiety, Practical advice, Talking to someone,

Using our minds (visualisation/distraction), Relaxation, Planning , Pursed lip breathing, Being

thankful, Mindfulness, Writing things down, Physical activity.


Allow group time to come up with their ideas.

Be prepared to rephrase question if you feel this will help the group to generate more ideas.

With permission from group you could add a few ideas from this list if they are finding it difficult.


Read the script slowly and allow plenty of pauses.Other facilitator participates in the relaxation exercise.

Explain that we can now do a guided imagery exercise which will help us to become more accepting of our symptoms. The exercise will take approximately eight minutes.

Support your feet on the floor in front of you and allow your arms to rest by your sides or have your hands gently supported in your lap. You may find it easier if you lower your eyelids.

Imagine your breath is coming from lower down in your body. Just allow your breathing to settle into a natural rhythm for you. Breathing in through your nose and out through your mouth.

Notice the sensation of your breathing..... the feeling of the air going into your lungs.... and gently out again......imagine that with each out-breath you are becoming more relaxed......Notice how your muscles are softening.......

We can now allow each part of our body to become even more relaxed...... imagine each breath reaching down into our body......now breathe any tension out.......As you breathe in, imagine your breath going down to your toes and feet......as you breathe out .....your toes and feet relax....continue like this for a while.....

Now imagine your breath is reaching down to your knees and calves...... release any tension.....and with your out-breath release it just a little more......Now, breathe down into your thighs and hips....... as you breathe out allow any tension to flow away with your breath.....continue like this for a while. With your next breath allow it to reach down to your tummy.....breathe out and let go of any tension......do this a few more times.......


Read the script slowly and allow plenty of pauses.Other facilitator participates in the relaxation exercise.


Read the script slowly and allow plenty of pauses.

Other facilitator participates in the relaxation exercise.

There is a simple relaxation exercise which we can now do, which also improves body awareness. It can help us become more accepting of our symptoms and see them as just another sensation we feel. This will take about eight minutes.

Support your feet on the floor in front of you and allow your arms to rest by your sides or have your hands gently supported in your lap. You may find it easier if you lower your eyelids.

Imagine your breath is coming from lower down in your body. Just allow your breathing to settle into a natural rhythm for you. Breathing in through your nose and out through your mouth.

Notice the sensation of your breathing..... the feeling of the air going into your lungs.... and gently out again......imagine that with each out-breath you are becoming more relaxed......Notice how your muscles are softening.......

We can now allow each part of our body to become even more relaxed...... imagine each breath reaching down into our body......now breathe any tension out.......As you breathe in, imagine your breath going down to your toes and feet......as you breathe out .....your toes and feet relax....continue like this for a while.....

Now imagine your breath is reaching down to your knees and calves...... release any tension.....and with your out-breath release it just a little more......Now, breathe down into your thighs and hips....... as you breathe out allow any tension to flow away with your breath.....continue like this for a while.

With your next breath reach down to your tummy.....breathe out and let go of any tension......do this a few more times.....


Read the script slowly and allow plenty of pauses.

Other facilitator participates in the relaxation exercise.

With your next breath, breathe into your head and neck....... let go of the tension with the out-breath....Notice how you are feeling as you just allow your breath to come and go naturally..... enjoy the sense of calm and relaxation. Take a moment now to notice how you are feeling.... if you are still feeling any tension, just imagine that tension going as you breathe out and enjoy the sense of calm and relaxation.

Slowly become aware of where you are... in your own time gently open your eyes. Remain still and quiet where you are for a moment before gently moving.

acknowledge that this can be a difficult skill to learn and requires practice summarise the benefits of relaxation and helpful breathing suggest that if people find it helpful and wish to know more they could find out about Mindfulness


Continue to read the script slowly.

Allow participants time to recover themselves.



Allow participants time to

With your next breath, breathe into your head and neck....... let go of the tension with the out-breath....Notice how you are feeling as you just allow your breath to come and go naturally..... enjoy the sense of calm and relaxation. Take a moment now to notice how you are feeling.... if you are still feeling any tension, just imagine that tension going as you breathe out and enjoy the sense of calm and relaxation.

Slowly become aware of where you are... in your own time gently open your eyes. Remain still and quiet where you are for a moment before gently moving.

Some people find this quite difficult to start with it; is something that needs practice. Relaxation and breathing help to reduce anxiety and produce good chemicals that make us feel calm. If you are interested and want to explore this technique further you may want to find out about Mindfulness.



Allow participants time to

Module B Activity B9: Planning

Aim: To introduce planning as an important self-management skill and to consider the benefits.Objectives: understand what is meant by planning appreciate how effective planning can improve quality of life look at ways to plan activities in daily living recognise that effective planning is a dynamic process which changes day-to-day and over time

Activity: Planning

Time: 20 minutes

Requirements: Questions to help us plan chart, Prepared modelling box.

Number of Pages: 6


Refer to the questions on the chart.

Introduce planning as important self-management skill

Suggest some situations when planning may be helpful

Explain that planning also helps us to maintain activities which are important to us

Acknowledge that having a health condition means we live with limitations and suggest some of these – eg pain, shortness of breath, not going into crowds, so we need to use our energy and time wisely

Explain that if faced with a challenging task we first need to assess how important it is for us to complete it ourselves and should then consider

Questions to help us plan How long it will take? When is the best time to do it? What help do I need to do it? Can I break it down into chunks? What do I need to do to prepare for it? What do I need to do to recover afterwards?


Read the questions on the chart.

Planning plays an important part in managing a health condition and allows us to feel in control but it means different things at different times.

Planning can be helpful when preparing to attend a medical meeting and also when we have a setback or are experiencing challenging times. It allows us to spend time thinking about which area of our self-management needs to be worked on.

Planning helps us to maintain activities which are important to us. Having a health condition means that we may live with certain limitations; these could be because of pain, shortness of breath or not feeling able to be in crowded settings. So, we need to use the energy and time we have available, wisely.

If a challenging task needs to be undertaken we first need to decide whether it is important that we do it ourselves or whether we ask someone else to do it.

Once we decide we want to do the task, we then need to consider a number of different things:

Questions to help us plan How long it will take? When is the best time to do it? What help do I need to do it? Can I break it down into chunks? What do I need to do to prepare for it? What do I need to do to recover afterwards?


Model an activity which is important to you; one you found difficult in the past but which you now successfully carry out with careful planning.

Allow 5-10 minutes for this activity depending on how the discussion is flowing.

Facilitators circulate around small groups and offer support if required.Reconvene the group.

Explain that it is really easy to overdo it when we are well and then feel worse afterwards and that though it may be worth it at the time, in the long run we can lose confidence and so feel more disabled

Suggest we may even begin to dread things we used to like such as celebrations and holidays; we can feel even more disabled by our health condition

Invite group to work in small groups of three or four Ask them to share with group an activity which is important to you but which

you currently finding difficult and would benefit from planning Suggest they use the questions on the Questions to help us plan chart and that group will be able to

offer some helpful ideas Summarise by saying that:

– Planning is a helpful self-management tool in many situations but particularly when faced with new or difficult situations

– Planning helps us to feel in control when the going gets tough, to carry on doing the things which are important to us and take on new challenges


Model an activity which is important to you; one you found difficult in the past but which you now successfully carry out with careful planning.

Allow 5-10 minutes for this activity depending on how the discussion is flowing.Facilitators circulate around small groups and offer support if required.Reconvene the group.

Planning is important because without it, it is really easy to overdo it when we are feeling well which then leads to us feeling worse on the days following. Whilst we may feel this is worth it at the time, by not planning ahead it may mean that in the long run we gradually lose confidence to do things which are important to us and so we feel more disabled by our health condition. Even things we really enjoy like celebrations and holidays become something to be dreaded.

–––––––

Perhaps you would like to work in small groups of three or four. Share with your group an activity which is important to you but which you are currently finding difficult and would benefit from planning. You can use the questions on the chart and your group will be able to offer you some ideas which may help you.

What and how we plan will depend on many things. After a setback or when faced with new or difficult situations, planning becomes an important tool for optimal self-management.

Planning helps us to feel in control when the going gets tough, to carry on doing the things which are important to us and take on new challenges.

Module B Activity B10: Becoming a resourceful self-manager

Aim: To allow participants to consider some of the difficulties they have in communicating their needs and feelings with a range of different people

and to consider some solutions to these challenges.

Objectives: consider why improving their willingness and ability to communicate their needs and feelings can be helpful identify the different components of communication have some insight as to how verbal and non-verbal communication affects people around us consider the use of different techniques to help resolve communication problems

Activity: Communicating our needs and feelings.

Time: 20 minutes

Requirements: Prepared flipchart with phrases from the role-play.

Number of Pages: 10


Facilitator models a situation where they have had to ask a colleague / family member for help and how that felt.


Module B Activity B9: Communicating our needs and feelings

Introduce communication by acknowledging that although it can sometimes be difficult it is an important part of life with a health condition

Suggest some situations when we may need to share our needs and feeling with friends, family or colleagues

What situations have you been in where you may have had to talk to other people about how your condition affects your life? You may have had to ask someone for help, how did that feel?


Facilitator models a situation where they have had to ask a colleague / family member for help and how that felt.



Communicating our needs and feelings to other people can sometimes be quite difficult. When we live with a health condition it is important to communicate clearly about things we need and how we are feeling to a variety of people.

Perhaps we need to talk to colleagues about the impact our health condition has on our work or we might need to ask a family member for help.

What situations have you been in where you may have had to talk to other people about how your condition affects your life? You may have had to ask someone for help, how did that feel?


Suggest that helpful communication can have a beneficial effect on our health condition, whereas getting it wrong can lead to resentment, disappointment and frustration

Explain that communication is about more than getting heard, it is about:– Knowing what we want to get across– Working out how and when to get the message across to someone else in a way they can

understand– The words we use and stress, our tone of voice– Body language and facial expression-sometimes tension, pain and anxiety can appear to

others as – anger– The aids we use to assist us, stick, mobility scooter, inhalers communicate something to other

people Explain that if we keep trying and failing to communicate with other people we may give up trying and

feel that nobody is interested in our situation Suggest that in this case we could look at why this is so:

– Is the language we use unhelpful? – Is our facial expression or body language not quite right?

Suggest that if we are unable to communicate how we feel to other people they will make up their own minds about how we feel and perhaps get it wrong

What was (Co-facilitator) communicating? How did she/he do that and why?How do we communicate non-verbally when we feel unwell?


At this point and without comment one facilitator models having a painful knee by rubbing it and grimacing.


The way we communicate can have an impact on our health condition. If we get our communication right it can be very helpful. If we get it wrong it can lead to resentment, hurt feelings and frustration. Helpful communication is more than just making yourself heard. It involves knowing what the message is that you want to get across… and then working out how to get that message to the other person in such a way that they will be open to hearing it and will understand it.

Whilst the words we use are important the way we use the words matters too... our tone of voice and which words we stress.

Our bodies and faces also communicate things to other people. Sometimes when we feel worried or tense or in pain we can give the impression that we are feeling angry.

Even things we use to help with our health condition can give a message to other people... things like a walking-stick, a mobility scooter or an inhaler.

If we keep failing at getting across the message about what we need and how we feel, we might eventually give up trying and begin to feel that nobody understands us or cares what we are feeling.

If we find we are getting our communication wrong, perhaps we could look at why this is so. Is the language we use unhelpful? Is our facial expression or body language not quite right?

Often a health condition is invisible to other people. If we are not able to tell people how it feels and how it impacts on our lives, they will make their own assumptions about it.

What was (Co-facilitator) communicating? How did she/he do that and why?How do we communicate non-verbally when we feel unwell?


At this point and without comment one facilitator models having a painful knee by rubbing it and grimacing.


acknowledge that most people use these unspoken signals to communicate our needs explain that this sometimes works for a while but are then ignored by other people suggest that sometimes we use language which blames the other person and leads to defensiveness

but that there are some things we can try which can help

Introduce role-play:

Role-play

Partner 1: You really don’t get it, do you?

Partner 2: Rather than having a go at me, why can’t you just make sure you are ready rather than lounging around?

Partner 1: You were the one who was in the bathroom for an hour.

Partner 2: Well, that’s because you didn’t tell me you needed it, I thought you were having a lie down

So, what did you notice?



Most of us use these signals occasionally, to draw the attention of someone and to ask for their concern.This works for a while - people respond the way we want - but eventually people stop noticing, or even ignore our signals. So we need to find different ways to communicate.

One way we sometimes get it wrong is by using language which blames the other person and leads to them becoming defensive. There are a couple of things we can try which can help us.

Perhaps you may hear this as we do this role-play.

Role-play

Partner 1: You really don’t get it, do you?

Partner 2: Rather than having a go at me, why can’t you just make sure you are ready rather than lounging around?

Partner 1: You were the one who was in the bathroom for an hour.

Partner 2: Well, that’s because you didn’t tell me you needed it, I thought you were having a lie down.

So, what did you notice?


Both facilitators take a role.

The word YOU, Blame, Both become

defensive, No attempt to listen, Nothing achieved,

Certain words stressed.


How could this conversation go differently?

Can you rephrase any of these?

Suggest that using ‘I’ rather than ‘you’ is less blaming and allows the other person to be less defensive

Summarise by saying that the aim of good communication is mutual understanding and finding a solution which is win/win

Acknowledge that helping others to understand your experience is difficult and requires perseverance and effort


Following the discussion use pre-prepared flip chart with these phrases from the role-play:

Invite group to suggest some more helpful phrases, you may want to scribe these. Allow discussion and time to get this right as it can be difficult at first.


How could this conversation go differently?

Can you rephrase any of these?

Using ‘I’ rather than ‘you’ is less blaming and helps the other person to be less defensive and more able to understand your point of view rather than feeling attacked.

The aim of good communication is mutual understanding and finding a solution where both people feel happy with the outcome. It is not about one person ‘winning’ the argument but both people benefiting.

Helping other people to understand something of our experience of living with a health condition is difficult, but finding the right time and the right words can help us. If we get it wrong the first time, don’t give up; try something different the next time.

You really don’t get it do you? You were the one who was in

the bathroom for an hour. That’s because you didn’t tell me you needed the bathroom


Following the discussion use pre-prepare a flip chart with these phrases from the role-play:

Invite group to suggest some more helpful phrases, you may want to scribe these. Allow discussion and time to get this right as it can be difficult at first.


Aim: To enable participants to continue to develop in their self-management skills and to become confident resource-finders.Objectives:

recognise that Self-Management does not begin and end with a Self-Management workshop consider the support options available to help with future goal-setting and follow-up identify and reflect on some of their own needs as a self-manager consider ways that they can identify local and national resources to get the Self-Management support they need

Activity: Becoming a resourceful self-manager.

Time: 20 minutes

Requirements: Becoming Resourceful Chart, Problem-Solve Cycle, Flipchart.

Number of Pages: 8


Indicate the Problem-Solving Cycle chart on the wall.

PS


acknowledge that before coming to these workshops, they were already self-managing to some extent since coming to these workshops they have learnt to solve problems using a process that we

represent with a cycle sometimes solutions are not obvious and so we also need to be resourceful mention being resourceful helps us towards achieving optimal self-management

Use the chart below:

Becoming Resourceful How else might I get what I need? Who else has information that might help me? Is there something very similar which might also work? Who else has expertise in this field? What is another thing I can try? What would I suggest someone else could do in a similar situation?


Indicate the Problem-Solving Cycle chart on the wall.

PS


Before you started these workshops you were already self-managing to a greater or lesser degree and when you have completed them, you’ll probably want to continue to develop as a self-manager.

Good self-managers are good at recognising barriers and at identifying solutions. We are able to use the steps of the problem-solving cycle to help us.

Not all solutions are immediately obvious, so as well as being problem-solvers, good self-managers are also resourceful. They become skilled in finding out the information they need to get the result they want. Sometimes finding the information we need requires determination, energy and confidence.

A resourceful self-manager is able to juggle the varying aspects of living with a health condition with their everyday life and so becomes an optimal Self-Manager.

To help us in our search for solutions to the everyday problems we encounter, here are some useful questions we can ask ourselves:

Becoming Resourceful How else might I get what I need? Who else has information that might help me? Is there something very similar which might also work? Who else has expertise in this field? What is another thing I can try? What would I suggest someone else could do in a similar situation?


Ask the group to think about where future support will come from

What can we do to get the support we need once these workshops are over? What support is available locally? Where do you already get support? Is some support more helpful than others? If so why?


This discussion could be for the whole group or for small groups with a facilitator in each group.


During these workshops we encourage you to share information and ideas and work with the group on joint problem-solving and goal-setting. This means we hear the ideas of many different people and can choose the

ones that suit us.

How can we ensure we’re able to access appropriate help and support to continue with our self-management? The answer is often... from other people. Self-management is not always about doing it single-handedly.

What can we do to get the support we need once these workshops are over? What support is available locally? Where do you already get support? Is some support more helpful than others? If so why?

Support groups, Volunteer centres, Libraries, places of worship, Friends

and Family, Phone book, Local paper, Shops, Clinic, GP, Pharmacy, Follow-on

sessions as a group, Internet, Social networking.



In what situations might we need support and information?

Say something about needing help sometimes is OK.



In what situations might we need support and information?

The goals we set do not always need to relate directly to our health condition; sometimes a goal could be around accessing information or support which will help us in our efforts to improve the management of our health in the longer term.

Sometimes asking for help and support from other people can feel hard; but, people might be ready and willing to help but just don’t know how to offer it until we ask them. We can help them by being clear about the help we need.

Managing medication, Making decisions about treatment, Maintaining mobility, Exercise groups, Eating / cooking healthily, Adaptations to the home, Driving a car / transport, Goal-setting / Self-care plan, Support

during setbacks, Accessing benefits / financial support, Changing career, Social activity / groups.

Module B Activity B11: Recognising and managing setbacks

Aim:

To explore the meaning of setback in context of a health condition, to enable recognition and management and to develop a recovery plan.

Objectives:

recognise that setbacks sometimes happen despite good Self-Management recognise what is meant by a setback consider what a Self-Management setback recovery plan may include

Activity: Recognising and managing setbacks

Time: 20 minutes

Requirements: Why is it helpful to have a setback plan? Chart, Flipchart

Number of Pages: 8


One facilitator models an example of a setback which occurred because of something they did or didn’t do eg moving house.

Other facilitator models an example of a setback which came about simply as part of the nature of the health condition.

Invite the group to share their triggers. Watch out for unhelpful health beliefs here and gently challenge these.


introduce setbacks as one of the changes brought about by living with a long term health condition explain that setbacks are sometimes called different things eg relapses, flare-ups, exacerbations,

depending on the actual condition explain that setbacks happen despite good self-management and that self-management is still helpful

even during a setback

Briefly explain triggers and give examples

What are the things which you know trigger setbacks for you?


One facilitator models an example of a setback which occurred because of something they did or didn’t do eg moving house.

Other facilitator models an example of a setback which came about simply as part of the nature of the health condition.

Invite the group to share their triggers. Watch out for unhelpful health beliefs here and gently challenge these.


One of the changes we may have to manage in life with a health condition is a set-back. Different conditions have different names for these - they can be called relapses, flare-ups, exacerbations or something else.

At times like these self-management can be very helpful. Setbacks can vary in length, severity and recovery time and they can happen for many different reasons, some of which we cannot explain. Sometimes a setback is triggered by something we do or even by something we don’t do. However sometimes they just happen. Setbacks are simply a part of life with a health condition.

Sometimes there are triggers which we know may lead to a setback like social events or infections. Some of these may be avoidable but often they are not. It might be helpful to think about this to see if there are triggers to your setbacks.

What are the things which you know trigger setbacks for you?


Invite the group to share their warning signs.

Draw attention to this chart by pointing out the questions or asking for more ideas.

Invite the group to discuss the questions.Explain that this list is in their booklet/pack.

Invite the group to share who they might involve in their plan.


briefly explain warning-signs but acknowledge that sometimes setbacks do occur without warning

How do you recognise warning signs that a setback is looming?

acknowledge that setbacks can lead to us feeling a range of different emotions, including fear, sadness and worry

use chart to identify why a setback plan is helpful

explain that health professionals can help you with medical management of your plan

Who else would it also be useful to talk to about or involve in your plan?



Invite the group to share their warning signs.

Draw attention to this chart by pointing out the questions or asking for more ideas.Invite the group to discuss the questions.Explain that this list is in their booklet/pack.

Invite the group to share who they might involve in their plan.


Sometimes we have warning signs that a setback is on its way, perhaps we feel more tired or more breathless. At other times the setback arrives seemingly ‘out of the blue.’ If we are able to recognise warning-signs we may be able to change our treatment or to get medical advice sooner.

How do you recognise warning signs that a setback is looming?

When we have a setback, for whatever reason, it can be helpful to acknowledge that we have feelings of sadness, worry, fear and disappointment; if we can accept these feelings we can start to come to terms with them. After a while we will feel ready to make a plan for our recovery which enables us to see the setback not as the end of the road but rather as the beginning of the way forward.Why can a plan be helpful?

It might be helpful to talk to your GP or other clinician about your setback plan; they can provide information and advice around the medical management.

Who else would it be useful to talk to about or involve in your plan?





You can use the cloud to write down your own ideas. With permission from the group you could add a few of these ideas if they find it difficult.

There should be a copy of a setback plan in their pack for them to complete.


If we feel that a setback plan would be helpful, what might we have in it?

acknowledge that every setback plan is unique and will depend on many factors invite the group to work in pairs or small groups to consider the sort of things they would want to

include in their setback planSummarise that setbacks are a part of life with a long term condition and that having a setback plan allows us to remain in control and to recover better.




The cloud provides other ideas. With permission from the group you could add a few of these if they finding it difficult.


If we feel that a setback plan would be helpful, what might we have in it?

Everyone’s setback plan will be different, as it depends on home and family arrangements, the health condition, the length and severity of the setback and the amount of support needed from others people.

Perhaps you would want to jot down some ideas for your own plan. You might like to do this with a partner or in a small group. There is a Setback planning sheet in your pack you could use.

Setbacks are part of life with a health condition, being aware of triggers and warning signs may be helpful for some people, however having a plan for recovery can be helpful for everyone.

Goal setting, Problem solving, Help from others, Prescribed medications, Food,

fluids and nutrition, Exercise and physiotherapy, Treats, Relaxation, Rest,

Sleep management, Planning and pacing.


For further information:Tel: 0207 257 8000www.health.org.uk

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