Empowering Patients for Healthy Lifestyles in Jyväskylä: PEDE Project Insights

1. Greetings from Jyväskylä, Finland, Human technology city Leena Liimatainen 19.5.2005

2. Empowering hospital patients for developing healthy lifestyles – what can the Jyväskylä PEDE-project contribute? Leena Liimatainen, Ph.D. Head of the Postgraduate degree program, Principal Lecturer in Health Promotion, Jyväskylä Polytechnic, Finland Dublin, Ireland 19.5.2005 Leena Liimatainen 19.5.2005

3. Challenges in lifestyle counselling, patient education and intervention planning Leena Liimatainen 19.5.2005 • In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health (WHO 1998). • counselling is based on principles of health promotion • key issues are partnership, networking and reciprocal conversation in a confidential relationship • recognize patients’ competence, resources, and explanations of action styles as well as coping and support networks • patients have an opportunity to plan what to do next, how to go on, and to construct their own solutions to health issues

4. Leena Liimatainen 19.5.2005 2. Lessons from meta-analyses exploring the effects of patient education and implications for educational interventions (Cooper et al. 2001, 2003) • The educational interventions tested were poorly described and failed to adhere to theoretical models. ->interventions were described by their content (diet, exercise, stress management) rather than their learning/ teaching activities

5. Leena Liimatainen 19.5.2005 * There is a need to develop educational initiatives that utilise the principles of adult education, which aspire to affect feelings, thinking and behaviour. * Practitioners need to use theoretically based teaching strategies to empower patients to make informed choices so that they can transform their knowledge into practice * Theoretical models of behaviour need to be integrated into models of education.

6. Leena Liimatainen 19.5.2005 • The outcomes measured were limited by a biomedical approach to education. * Interventions need to be designed also addressing outcomes such as quality of life, personal models of illness and empowerment in spite of physical outcomes and compliance with self-care instructions

7. Patient Education Development Project(PEDE-project) Leena Liimatainen 19.5.2005 To meet the challenges, the Patient Education Development Project (PEDE –project 2002-2004) was started in the internal medicine units of the Central Finland Health Care District. The project involved about 350 nurses and 23 internal medicine units

8. The aims of the project Leena Liimatainen 19.5.2005 • The nursing staff will acquire new empowering patient education skills 2. The counselling practices, materials, networks and quality assuring methods are renewed in the working units.

9. Theoretical framework of the project Leena Liimatainen 19.5.2005 • Action research project • Experiential (Kolb 1984) and transformative (Mezirow 1991) learning models were used to facilitate both individual and organisational learning and change processes in the project • The project realized the “HPH” –programme with a special emphasis on promoting the health of the patients and staff by creating a health-promoting and empowering nursing culture. • Principles: Health Promotion, Empowerment, Participation

10. Experiential learning model (Kolb 1984) as the framework of the PEDE-project Leena Liimatainen 19.5.2005 Developing patient education by studying the practice Experiences from daily practice, Action Observation, Reflection, Evaluation Experimentation, Application Understanding, New models of action Learning Results: Changes Team - Knowledge, skills,values - Attitude, experience, - Working practice, culture Individual - Knowledge, skills - Attitude, - Experience Organisation - Knowledge, - Way of action - Process, culture, value - Experience

11. The implementation of the project Leena Liimatainen 19.5.2005 PEDE - Project Patient education development in the working units (n=23) New empowering patient education skills for the nursing staff Change agents Exploring the development needs of patient education practice using self-evaluation questionnaires and consultations Planning, implementation and evaluation of the patient education development projects (n=19) in the wards Co-operation with change agents, staff, managers from hospital, patient organisations, students, tutors from JYPOLY Education programmes Information technology and evidence based counselling skills programme (n=56) Education programme for change agents (n=56) Empowering patient education programmes (n=198) Change agents Changes in patient education practices within internal medicine units of the Central Finland Health Care District Change agents New empowering patient education competence

12. Empowering patient education programme Leena Liimatainen 19.5.2005 • was based on a context-bound training method and experiential learning process using videotaped counselling situations from everyday patient education practice. • Interactive and reflective workshops, distance and self-guided learning. The contents of workshops: • The principles of empowering counselling (Poskiparta, Liimatainen et al. 2001, Kettunen 2001) • Interventive interviewing (Tomm 1988) and the Stages of change –model (Prochaska & DiClemente 1983) facilitating health behaviour changes • Teaching ageing patients; constrains and challenges.

13. From Self-evaluation of patient education practices to development plans and changes Leena Liimatainen 19.5.2005 Evaluation Targets 1. Value basis 2. Structural factors 3. Education process 4. Life-style counselling factors Self-evaluation Form Each main group is presented by 4-14 evaluation targets Summary Form ward specific profiles Conclusions and Development Plan

14. Results: New empowering patient education practices Leena Liimatainen 19.5.2005 • Shelving with empowering material and model to support quitting smoking and treatment for nicotine addiction • information desk (Health corner) at the internal medicine policlinic to support self care and self assessment (Diabetes prevention, Type 2 Diabetes Risk Test) • group counseling models for patients suffering from ischemic attack in the brain, rheumatoid arthritis, and for those needing dialysis treatment • new counseling material, 40 electronic instruction for patients, and an instructional video film for children suffering from asthma • quality criteria for patient education to be included in the care plan • PBL-based diabetes education programme for nursing staff

15. Results: changes in working units Leena Liimatainen 19.5.2005 • sharing tacit knowledge in the reflective learning of the working communities • implementing change in working units by means of change agents and a co-operational model • experience of professional growth and empowerment • linking patient education development work with the operational plans of the working units, and with strategic planning in the internal nursing area of operation

16. Measuring outcomes of the counseling from the empowerment approach Leena Liimatainen 19.5.2005 • Empowering speech practices scale questionnaire was piloted in the PEDE-project • ESPS describes the realization of empowerment directing attention to patient participation and was constructed on the basis of empowerment theory and foregoing conversation analytic research • 127 counseling sessions were assessed, and we got some evidence about the realization of empowerment. • According to the results, the nurses succeeded mostly in building a positive emotional climate and in giving information. • Nurses need to improve the active mutuality of the counseling relationship by asking patients’ opinions and views, by facilitating their own assessment of personal health, and participation in decision making and innovation of their individual care decisions

17. Recommendations Leena Liimatainen 19.5.2005 • The experiential learning model is a convenient adult education model, which will work on the levels of individual and organisational learning taking the experiences, feelings, thinking and behaviour of the participants into account • An experiential learning and reflective videotape based training programme is a useful tool teaching lifestyle counselling skills and integrating theoretical models of behaviour (Stages of change) into models of education • Virtual learning possibilities! • Empowering speech practices scale questionnaire needs further study * It can be used as a tool in quality assessment, and in empowering patient education programs

18. Leena Liimatainen 19.5.2005 “You cannot teach a man anything. You can only help him discover it within himself”. (Galileo Galilei)