Plan
Previous Topic
After you have assessed for difficulties in self-care activities, the next step is to develop a plan for how to deliver the interventions. The information gathered throughout the assessment should be used to plan the self-care interventions.
Follow the three steps outlined in the ‘Introduction to Rehabilitation’ module for planning rehabilitation interventions. These are
- Set a rehabilitation goal
- Select the right intervention and its dosage
- Support where needed with a referral to additional services
a. Set a rehabilitation goal
It is important to break down big goals into smaller goals which are functional and specific; short-term and timebound, achievable and relate to everyday activities.
For example, a person who has difficulties taking their medication and wants to be able to independently take it may have this goal “This week, on at least 5 out of 7 days, I will use my memory strategies to independently take my medicine every morning at 9 a.m.”
b. Select the right intervention and dosage
During the assessment, if the person answers ‘YES’ to any of the follow-up questions in the Care Modules, then there is the need to select the right self-care intervention and dosage for the person.
When selecting the right self-care intervention and dosage, there are a number of factors to consider. These include:
- Identify
the self-care activities that work for the person.
It is important to note that in planning self-care rehabilitation interventions, not all self-care activities will suit every person. For example, asking a person who has difficulty with dressing to practice buttoning clothes may not work for that person if they do not have any or are not used to wearing clothes with buttons. Pay attention to what matters most to the person and consider the person’s habits. If they have had similar self-care difficulties in the past, find out the activities that worked for the person.
- Identify the elements in the
person’s environment that can be used or modified to improve self-care
If there is anything in the person’s environment useful in providing self-care rehabilitation interventions, it may be helpful to use it. For example, the handle of a cup or spoon can be modified by wrapping a piece of bandage around it to improve grip for feeding. Similarly, family members can play an important role as caregivers in self-care activities if needed.
- Consider
how to make assistive products available to the person.
It is important in planning self-care rehabilitation interventions to identify what assistive products a person would need, where they might access them from, if funding is available to cover the cost or subsidize it, and who could install them.
Refer to the assistive products module for indications and how to select, fit and use these assistive products.
- Identify
the right pharmacological agents, when relevant and if it is within your usual
scope of practice.
Pharmacological agents play an important role in self-care and should be considered when planning. Identify the right pharmacological agents for improving self-care activities, their dosages and in planning, consider whether the agents are available, accessible and affordable. It is helpful to also consider whether the pharmacological agents are covered by insurance and where to access funding for them if not covered.
- Consider
how to fit the self-care activities into the person’s schedule.
When planning self-care rehabilitation interventions, it helps to start with the activities that the person needs and values most. This may change from time to time. For example, if a person has difficulties with bathing and socializing, it may help to start with education, advice or training in bathing before moving on to socializing.
- Consider
the most appropriate frequency and duration for carrying out the self-care
intervention.
Plan for whether the person needs to be seen multiple times, and how long you think each session will need to be. This may be influenced by the extent of the person’s needs, their fitness, level of fatigue, and pain levels.
When planning with the individual, be sure to:
- Find a quiet place to avoid distractions
- Involve caregivers or family members when appropriate
- Try to give education and advice using words that align with the person’s level of health literacy.
c. Support where needed with a referral to additional services
People with difficulties with self-care may require assistance and support at home and in the community, especially those people who have limited social supports. During the planning of self-care interventions, it is important to also plan for or refer to additional services based on assessment findings. For example, they may benefit from a referral for related interventions addressing muscle strength, gait, cognition and vision, or they may require support to perform self-care tasks, such as assistance with dressing, cooking or shopping.
Referrals can also be made to support services for the following:
- Assistance with household care through a hired caregiver
- Residential support services (eg. group living homes, rehabilitation facilities)
- Community access (eg. day care centers)
- Communication support (eg. sign language interpreters)
- Financial support (eg. disability support grants)
- Information and advice services (eg. Peer support, advocacy)
Activity
Remember Dai?
Dai is 65 years old and was involved in a road traffic accident 6 weeks ago, that resulted in him having his right leg amputated below the knee, and a traumatic brain injury. He had rehabilitation while in hospital, and is awaiting a prosthetic leg, although the wait list is long. While he waits, Dai moves around with axillary crutches. His head injury has recovered well, but he has problems with emotional control, as well as reduced memory and concentration.
During an assessment interview at the local clinic, Dai tells you that he can get into the family bathroom at home. However, they have a squat toilet, and he cannot squat.
He also finds standing to wash himself very difficult with the amputation and therefore needs assistance. Before his injury, Dai worked in a restaurant as a cook, and on the weekends, he played football. Dai’s mood has been very low recently as he cannot return to his job or play football with his friends.
Activity:
Draft a self-care rehabilitation plan, imagining that you are doing so together with Dai:
1. Based on the information provided, what could be three possible goals for Dai’s self-care rehabilitation? Practice writing these goals so that they are functional and specific; short-term and timebound, achievable and relate to everyday tasks.
2. Now that you have identified three goals - What factors should you keep in mind when selecting the right interventions and dosage? Write your ideas in the space below, considering the following questions:
- What self-care activities matter most, or are of biggest concern to Dai?
- Are there any elements in Dai’s reported environment that could be used or modified to improve his self-care?
- Would Dai benefit from any assistive products? What assistive products does he already have, or are already being organized for him?
- Would Dai benefit from pharmacological agents based on the difficulties he reported?
3. Do you think that Dai requires a referral to any additional medical or support services? If so, what services?
Question
Remember Tevita?
Tevita’s doctor did an assessment to identify her self-care difficulties. The assessment found that she had difficulties with Activities of Daily Living (feeding, household chores, bathing) and Instrumental Activities of Daily Living (shopping and using the telephone). Based on these findings, Tevita and her doctor started planning her rehabilitation.
First, they decided on her rehabilitation goals. One of her goals is to eat with cutlery independently during mealtimes without spilling her food, and she aims to achieve this by the end of the month.Tevita’s doctor then selected the self-care interventions to include in her rehabilitation plan. Which of the following interventions may help Tevita in achieving her goal?
Select all that apply.
- a. Education and advice on strategies to minimize her hand shaking
- b. Organize a home caregiver to feed her everyday
- c. Practice eating with a spoon, and not spilling
- d. Using modified cutlery, to improve her grip and hand control
- e. Engage in muscle strengthening exercises to reduce risk of falls
If you selected ‘a’, ‘c’ and ‘d’, you are correct . While ‘b’ would also aid in her feeding, it does not help to achieve her goal of feeding independently.
