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06.05.09 by Mary Jo Kreitzer, RN, PhD

Self Care: Key to Health Reform Worldwide

I had the opportunity this week to spend time with National Health Service colleagues in Manchester, England, where I gave a keynote address at a conference called Self Care Aware.

During the past three years, the National Health Service (NHS) has been implementing a self care strategy that focuses on individuals taking responsibility for their own health and well-being. It is a strategy that goes to the heart of health reform and strives to balance rights and responsibilities with informed choice. In his opening remarks, Chief Executive of NHS North West, Mike Farrar, acknowledged the profound culture change that this will demand.

Throughout the day, there were many brilliant examples of self-care initiatives including a self-care toolkit for people with chronic illness and a program called The Calm Zone, which is targeted at young men ages 15-35 that offers help, information and advice on work issues, financial stress, bullying, relationships, self-harm and suicide. A six-week course called Self Care for You teaches people how to manage minor ailments, acute illness, long-term conditions, and adopt healthy lifestyle behaviors.

Every organization within the NHS in this region is expected to make self care a major focus of their work. While I have seen many healthcare organizations and systems through the years embrace new directions, too often the changes are cosmetic and don't really address core values and priorities. I found the progress that has been made here in England and the commitment to self care to be nothing short of stunning and a wonderful model for other countries, including the U.S. My address titled Transforming Health Care: Patient Empowerment echoed some of the conference's self-care strategy and included information about our website Taking Charge of Your Health.

What do you think about self care's role in reforming our healthcare system?

 

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Comments

Self-care is critical to the

Submitted by Barbara Glickstein (not verified) on June 5, 2009 - 4:05pm.
Self-care is critical to the health care reform debate and our model must include it. Innovative health care models understand are grounded in supporting positive health behaviors supporting people to make difficult changes related to diet, exercise, stress reduction and smoking cessation. This is true prevention and a good public health model. Barbara Glickstein, RN, MPH, MS New York, NY

Self-Care

Submitted by Anonymous (not verified) on June 6, 2009 - 10:13am.
I agree. As a physician, I see over 100 patients per week. It is saddening to see how patients take no personal responsibility for their well-being. They take in an unhealthy diet, smoke and drink too much, and expect the physician to "fix" the problem with a pill.

self-care

Submitted by Anonymous (not verified) on June 8, 2009 - 6:46pm.
You raise an interesting and important topic in your blog, Mary Jo. After working in the health care field for more than fifteen years – first as a nurse and then as an attorney – I believe that all individuals deserve access to health care. Yet the idea of self care is equally important and must be included as an integral part of health care ... Read Morereform. Self care necessarily requires individuals to examine their behavior and consider what they can do to preserve and improve their health. This does not diminish the importance of making access to health care achievable and affordable, but rather suggests the importance of cultivating both “health care” and “self care”

I appreciate the comments

Submitted by Sue Towey RN CNS MS LP (not verified) on June 9, 2009 - 8:39am.
I appreciate the comments that support a "both/and" healthcare system model. I would also add the caution against "blaming" patients who do get sick or injured in spite of their diligent efforts at self-care. Can we also honor the Mystery of the human experience?

website and information

Submitted by Jean Watson (not verified) on June 11, 2009 - 10:36am.
This is an important, dynamic website, offering latest thinking about reform/transformation of health views and health care reform for self, systems and society. Thank you Mary Jo and all. Jean

Self-Care

Submitted by Bill Manahan, MD (not verified) on June 11, 2009 - 10:44am.
Individual responsibility is certainly an important part of improving health. At the same time, I believe that until we improve the health of our country, our communities, and our homes, changing individual behavior will be difficult. Education and healthcare being part of a more collaborative model would be a big step in assisting individuals make important changes. We are products of our environment and of our culture. When war, profits, competition, and individual gain are the dominant paradigm, it is difficult to make healthy individual choices.

Self Care

Submitted by Howard K. Bell, M.Div (not verified) on June 11, 2009 - 11:40am.
I concur that self care is essential for health reform. It is also an opportunity for self-empowerment where the recipient of health care can participate in their healing physically, emotionally, psychologically, and spiritually.

Self Care

Submitted by Bob Sheeler (not verified) on June 11, 2009 - 12:01pm.
Self care is a privilege and responsibility of those who are at a place in their life where they can model this behavior. For many of our patients and clients it is something that is beyond their physical, economic, and psychological reach. Both by modeling self care as a health provider and educator and by working to improve the resources available cultural change can happen at broader levels. I believe that we are on the verge of cultural shifts in thinking in many areas - with luck - this could be a facet of our society that is ready for rapid evolutionary or even revolutionary changes in thinking and behavior.

cultural shifts

Submitted by Jennifer Blair, LAc. (not verified) on June 11, 2009 - 3:52pm.
I agree with both the physician's comments about some patient's wanting to be 'fixed' and Sue Towey's response regarding the mystery of life and illness. We are moving into a time that can embrace these paradoxes. It is our culture that has created a system of medicine that not only encourages, but demands compliance and capitulation. To solve this, we must, as Mary Jo so clearly states, educate, empower, acknowledge and provide access to the simplest and best paths to our whole health. No one approach solves the dilemma. I had the opportunity to hear Mary Jo speak on this topic recently. Years of experience on the forefront of this cause make her one of the few leaders who can clearly articulate both the dilemma and the solution.

Caring for Ourselves, Caring for Others

Submitted by Susan Luck (not verified) on June 12, 2009 - 6:03am.
For health care reform to be truly effective, there needs to be a component that supports and implements strategies for teaching self care for the health care provider. We know that stress on the job can lead to burn out and loss of passion and meaning in our work. If we are not present with ourselves and we are energetically depleted, how can we be effective and have a healing presence and fulfill our intention that brought us to this sacred work?

health reform and health care financing reform

Submitted by Anonymous (not verified) on June 12, 2009 - 8:34am.
I agree that there is a huge need for better self-care, but right now much of the stress on our people is financial, a large part of which is related to high health-care costs and uncertainty about coverage. This would be dramatically reduced by a health-care system that was mostly publicly funded and provided automatic coverage for all of us (i.e. single payer health care). Jim Hart

The good news is that

Submitted by Anonymous (not verified) on June 12, 2009 - 9:01am.
The good news is that compared to the cost of treating illness, education about self care is highly cost effective. Erik Storlie

Self-care is the cornerstone

Submitted by Selma Sroka MD (not verified) on June 12, 2009 - 11:32pm.
Self-care is the cornerstone of taking responsibility for my life and being as whole and healthy and happy as I can be. Having a written self-care plan or contract is a useful tool for being mindful about my commitment and responsibility to these goals, in every aspect of my life, i.e. physical, mental, emotional and spiritual. During the wellness teaching I do with family medicine residents I have them write their own self-care plans, which they will review and update periodically during their training. I have also asked patients to do this exercise in consciousness raising, because in this way, they often identify the areas they want to work on. This is person-centered care, as I have no right or power to impose my values and attitudes on another. And I can't make others happy and healthy any more than our government can make us happy and healthy. We are never satisfied for long with those external rewards, we just keep wanting more. We each seem to have to struggle and find our own way, and some seem to have an easier time of it than others. It depends a lot on what tools we have to start with and where we're starting from. Many of us did not have the best role models, and yet we are each ultimately responsible for the choices we make and how we manage this life, whether we recognize it or not. Unless we give our power away or become incapacitated, we can always choose make meaning of our circumstance, retrain ourselves to make healthier choices and seek out those that will support our growth and healing.

self care

Submitted by Mark Hoch, MD (not verified) on June 13, 2009 - 9:10am.
Only good care of ourselves and our communities will keep us healthy. We need healthcare in the "healthcare system". Time to wake up to the obvious, program it into our the system and live it. Mark Hoch, MD Past President, American Holistic Medical Association

Partnership

Submitted by Teddie Potter RN, MS (not verified) on June 13, 2009 - 10:54am.
I am a home care nurse serving acute and chronically ill patients. Each year I visit more and more people suffering with conditions that could have been prevented. I certainly believe that individual responsibility is part of the solution but I turn to the wisdom of our ancestors for a broader understanding. Through history, humans have missed the mark when too much emphasis is placed on self. I would encourage future models to strongly emphasize community and environmental relationships. These are critical partners in a healthy web of life.

Whole Systems Healing

Submitted by Louise Delagran (not verified) on June 24, 2009 - 12:10pm.
I think you are absolutely right about this. Our personal health is interwoven with the health of our community and environment. At the Center for Spirituality and Healing we call this Whole Systems Healing, and we offer courses to undergraduates to teach them the importance of this approach: http://www.csh.umn.edu/prod/groups/ahc/@pub/@ahc/documents/asset/ahc_933...

Self-care and Self-advocacy

Submitted by Jeff Westall (not verified) on June 14, 2009 - 7:05pm.
I think an important part of moving to a self-care centric model is ensuring everyone has the information and skills they need to be their own best advocate. This includes making decisions regarding your own care in the event you are unable to express your own wishes and sharing those decisions with everyone on your health care team.

Define Self Care

Submitted by Darlene Hess PhD, AHN-BC, PMHNP-BC (not verified) on June 16, 2009 - 8:44am.
Ah yes - self care. And, what is that exactly? We would each define it differently, of course, but for me, self care is doing what I can to be in alignment with what brings me inner peace and feelings of well-being - you know - gratitute and appreciation and all that stuff. So, what is interesting, and sometimes shocking as I experience the jolt that not everyone sees the world my way :-) is that many speak of health reform and emphasis on health promotion and prevention as providing more "tests" and offering "antihypertensives to all" (Medscape). I am concerned that self-care will be subsumed under issues of compliance and doing what the "evidence" indicates should be done. My point is that we have to define and frame terms, and not assume all understand self-care in the same way.

Self-care

Submitted by LBRobinson (not verified) on June 16, 2009 - 12:55pm.
Self care necessitates individuals being treated as sentient beings. "Doctor knows best" or "government knows best," works at cross purposes with encouraging personal responsibilty in the more inclusive approach you suggest, albeit your model holds great promise. Anything that advances an individual's knowledge and concomitant options enhances the probabilty that people can and will embrace caring for themselves and that they will experience positive results therefrom. Hopefully, you also encourage an examination of the meaning of care, of health, and of the linking of the two concepts within a wide array of possibilities. Otherwise, yours will be another model of someone else knowing best. Or maybe not. Maybe enrollees will reject as well as accept your "recipe" for self care so it does not become another "we know best" option. That you are broadening the health arena is a good thing.

Hopeful trend

Submitted by Jayne Felgen (not verified) on June 18, 2009 - 11:47am.
Mary Jo, your message is "spot on"! I have been encouraged that many hospitals have committed to transforming their culture espousing Relationship-Based Care principles. The focus of this work is caring for self, colleagues, and patients and their families. And, while getting the attention of care providers to recognize and accept responsibility for self-care has long been a challenge, we are beginning to see a positive shift occur as a result of staff engagement in a three-day retreat, Re-igniting the Spirit of Caring. Qualitative and quantitative metrics consistently support the successfulness of these interactive sessions, and hospital CEOs are pleased with the ROI as well as the participants. If we hope for the empowerment of patients to accept responsibility for their health and well-being, as care providers, we must model the way! I am thankful that many are beginning to truly embrace the possibilities of transforming health care and the care delivery systems from the inside out!

Personal Responsibility

Submitted by Kelly Victory, M.D. (not verified) on June 19, 2009 - 9:33am.
"Self Care" is absolutely critical not only to the health of the individual, but to the health of the population at large and our ability to create a sustainable healthcare system. Personal responsibility regarding health and lifestyle issues has been largely lacking in the US for years. The escalation in the incidence of obesity, heart disease, Type 2 diabetes, etc. is all reflective of that problem. Unfortunately, we have created and supported a cultural "norm" that allows us to blame everyone but the individual: Sue the fast food chains because we are fat, sue the tobacco companies because we have lung cancer and COPD, sue the school system because our kids aren't behaving properly, etc. Until we hold people responsible (financially and otherwise) for their modifiable health risk behaviors, we will see a continued downward spiral in the overall health of Americans, and a contunued escalation of healthcare costs. Part of that sea-change will require a new understanding of healthcare insurance; Auto insurance doesn't cover the cost to fill up your car with gas; homeowners' insurance doesn't cover the cost to paint your home or to have the lawn mowed; and healthcare insurance shouldn't be expected to cover "routine maintenance" either!

Self care and transformation

Submitted by Michele Okposo (not verified) on June 19, 2009 - 12:18pm.
In my experience as a health coach and registered pharmacist, when a client embraces an effective self care practice, and really has success in changing their bodies and/or minds, their entire perspective shifts. Embracing self care responsibility can improve self respect and deepens self awareness; and if the practices become embodied in their way of being, it shifts self love and self worth….the transpersonal psychology model in real world experience. What I have found is being good stewards of their own well being necessarily and automatically translates into more connectivity, understanding and compassion for those they live with, work with, and the environment that supports them. Great self care can lead to “reconciling the gaps”, as Orland Bishop so eloquently put it at our recent Ways of Knowing Symposium. First, with our support and encouragement, clients will find the gaps that produce the dis-ease in body or mind often displayed as symptoms of suffering. Next as healers we can assist them with finding a self care solution that they buy into or better yet, generate. Closing the gap continues by holding them accountable to their self care program. And yes, I agree, practicing what we preach is essential!

Absolutely the key to our

Submitted by Kate Hathaway (not verified) on June 22, 2009 - 3:01pm.
Absolutely the key to our future health! Wisdom has it that those who do not make time for exercise (or nutritious eating or good sleep or support systems or...) will have to make room for disease. I do believe that health care providers are MUCH better at educating than we used to be, and we are more interested in teaching self-care. Perhaps we can work to empower ourselves to teach more effectively, and to empower our clients/patients to be empowered to changes themselves, the way health care is provided, and their communities! P.S. Can we focus more attention on the future generations, to whom we bequeath our health challenges?

I think an important part of

Submitted by justjohnny (not verified) on June 29, 2009 - 8:59am.
I think an important part of moving to a self-care centric model is ensuring everyone has the information and skills they need to be their own best advocate.

Self Care and MD's

Submitted by Anonymous (not verified) on June 30, 2009 - 9:37am.
I have worked in the self care model for the past 25 years and every inch of it has been met with MD's laughing out loud calling alternative methods ridiculous, unproven and a waste of money. Before individuals will take responsibility for their health, MD's are going to have to at least be open to it because they currently hold all the influence over how health care is delivered in our country. The drug companies know this and educate MD's daily on the benefits of pharmaceuticals. This relationship needs to be examined if the self care model is going to take hold. The Hauser cancer case is a perfect example of Dr's completely taking control away from the family and saying their nutrition efforts were crazy.

whole system participation called for

Submitted by Kaia Svien (not verified) on July 2, 2009 - 1:35pm.
Reflecting on the thoughtful comments above and stories of dynamic change, it seems to me that nourishing self-care in our population calls for whole system participation. As usual, changing one piece of the structure can’t be done effectively alone and doesn’t have much chance to succeed until it is accompanied by other alignment shifts. Since so many of us have been energizing change in numerous channels, maybe we’re closer than we think to “flipping the pancake.” From another perspective, it’s illuminating to realize that while health care professionals and teachers are key sectors in bringing forth self-care for the public., they are amongst those workers most overworked and in need of self-care themselves. Perhaps self-care programs can be offered to these folks early on so they can be supported in the critical work they do and also authentically model the benefits of self-care.

Self Care Aware conference presentations

Submitted by Nicky Davies - Event Manager - Cynergy Events (not verified) on July 22, 2009 - 6:15am.
Anyone interested in gaining further information about the NHS North West 'Self Care Aware' event and strategy can find all of the presentations from the day at www.cynergyevents.co.uk/selfcarecentral/index.html

Take charge of your Health

Submitted by Dr Timothy Lim (not verified) on August 8, 2009 - 4:48pm.
We must learn how to take charge of our health. Whether it is for chronic diseases or a simple back pain problem, find out what you can for your self such as exercise, a positive outlook, learning to cook quality foods.

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