Promoting self-efficacy improves outcomes
Use these 6 methods to boost independence
By Ruth Davidhizar, RN, DNS, CS, FAAN
Dean of Nursing, Bethel College, Mishawaka, IN
Gregory A. Bechtel, RN, MPH, PhD
Associate Professor, Department of Community ursing, Medical College of Georgia, Augusta
Scott Wilson Miller, RN, MS, CPAN
Doctoral Candidate, University of California at San Francisco
Self-efficacy is of profound importance to the chronically disabled client. Clients with a strong personal belief in their own abilities when a disability occurs are able to cope much better with their disabilities. However, each client and each situation is different, and the personal factors operating at the time of disability often determine how positively your client responds to his or her disability. The support your client receives from you and other health care professionals can be therapeutic. That support can boost your client’s ability to cope and to achieve the highest possible function level. (For resources for further study of self-efficacy, see box, p. 21.)
Here are six methods case managers can use to help their clients cope with disability and promote the best possible outcomes:
1. Encourage realistic goal setting. No matter how small the goals may seem, setting goals your clients can achieve is important in influencing feelings of self-efficacy. Encourage them to set both short- and long-term goals. For example, a goal to be discharged home encourages the hospitalized patients to be conscientious about practicing physical therapy exercises and to endure pain as progressively more difficult exercises are mastered. Establishing realistic goals for improvement at each stage of clients’ rehabilitation enhances their ability to see that goals can be achieved.
2. Provide experiences with other disabled people. Support groups help clients see others with similar disabilities and provide successful role models to follow. Many disabled individuals have made major contributions to society, and sharing their stories with your clients provides hope and motivation. When you must approach clients with difficult or uncomfortable topics, use personal examples of frustration and courage. Communicating these feelings of empathy helps promote a positive outlook.
3. Provide ongoing affirmation. Verbal persuasion and affirmation help give disabled clients hope and reassurance that they can achieve an optimal level of function. Personal affirmation for achieving short- or long-term goals provides support for clients who may be hesitant to accept that achieving even small goals is an important step. Positive affirmation may be a simple as verbally recognizing clients’ achievements. A little praise from you can motivate their continued efforts to improve and work toward new goals.
4. Maximize physical and psychological function. You must support optimal physical and psychological function to enhance your clients’ feelings of self-worth. A tired client is more susceptible to depression, for example. Encourage clients to schedule naps during the day. Many disabled clients function best with a schedule tailored to their personal stamina level. Help clients work out a schedule that is challenging but not overtaxing. In addition, some clients may benefit from antidepressant medication to help overcome the chemical imbalance that sometimes occurs with a chronic disability. You must assess clients holistically. Astute case managers often recognize the disabled client’s feelings of hopelessness, inadequacy, depression, and discouragement. Be alert for warning signs that clients are dwelling on gloomy matters to the point of obsession. In cases where the prognosis is terminal, giving support and encouragement is often the most essential element in the client-family-case manager relationship. Referrals and the need for external support networks become a critical component of your clients’ care plans.
5. Provide motivation and encouragement for meaningful goals. Disabled clients often feel incapacitated. Case managers should be quick to support their clients’ choices, even if those choices do not seem entirely realistic. It is possible for clients to achieve even an unrealistic goal if their desire to succeed is strong enough.
Case managers who provide encouragement enhance their clients’ quality of life. Unless you help counteract negative cognitive and coping responses to your clients’ chronic disabilities, physical interventions may provide little value. Providing encouragement is an intervention of high priority for disabled clients and may require significant creativity on your part to help overcome clients’ feelings of depression and diminished self-worth. A supportive and encouraging approach to the entire care plan is much more effective in promoting self-efficacy and improving outcomes than efforts to simply "cheer up" clients. The single most important therapeutic approach is listening. When you work with clients, make sure you listen carefully as well as educate, inform, and advise.
6. Encourage personal belief in ability to cope. Chronically disabled clients often believe the disability has eliminated the coping techniques and strategies available to otherwise healthy persons. Their ability to cope is vastly more important than their actual ability to physically perform a function. In very few cases, clients may state a preference for not talking about their disabilities. However, your genuine concern provides a nonthreatening opening which invites clients to share feelings. Failure to ask about the situation has the effect of treating the disability as though it did not exist or is not worth talking or caring about. This often leads to increased feelings of isolation, which aggravate feelings of pain and uniqueness.
Availability is crucial to encouragement, but offering statements of faith also is beneficial. Even if clients do not have personal faith, they usually do not take exception to hearing about another’s. Sharing your faith in an ultimate good can encourage clients to cope with their disabilities.
Case managers must establish trust early in their relationships with chronically disabled clients to promote self-efficacy and positive outcomes. Enhanced physical and mental function increase feelings of independence and self-esteem. As your emphasis changes from an illness model to one of health promotion and risk reduction, you can help disabled clients measure outcomes by "what can be" instead of "what was."
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