Core principles on self-care increase patient responsibility

The government has launched new guidance to highlight the importance of nurses supporting patients in taking joint responsibility for their health. Nerys Hairon reports

The Department of Health has recently launched seven common core principles to support self-care, drawn up by Skills for Care and Skills for Health (2008). They are designed to help health and social care professionals support people to live independently, stay healthy and make the most of their lives by managing long-term conditions and other needs.

The guidance document outlines the core principles and what these mean for healthcare staff and other groups such as commissioners. For each core principle, the context and indicative behaviours expected of staff are detailed in the document.

Background

The guidance explains that consultation responses to the white paper Our Health, Our Care, Our Say (DH, 2006a) confirmed that people want control over their lives, enabling them, their families and carers to maintain and improve well-being and independence. Research evidence on the effectiveness of self-care support suggests there is significant potential for professionals to support self-care (DH, 2007; Hairon, 2007). This DH document gave many examples of types of self-care support, such as measuring their own blood pressure.

The core principles aim to help healthcare providers to give people control over – and responsibility for – their own health and well-being, working in partnership with professionals. They are intended to support self-care in its broadest sense, and will include but not be limited to people with long-term conditions or complex health and social care needs.

The guidance describes self-care as to practices undertaken by patients, service users and carers that involve people taking responsibility for their own health and well-being. Self-management involves people coping with their difficulties and making the most of what they have. It includes managing or minimising the impact of conditions on people's lives, as well as what they can do to make the most of their lives despite the condition.

The guidance stresses that self-care involves partnership working, in which both patients and healthcare professionals contribute to care planning – it is not about healthcare staff handing over responsibility to their patients.

The core principles

The principles reflect the approach to self-care outlined in the DH's (2006b) guidance. They should be used alongside existing tools such as national workforce competences, national occupational standards and the Knowledge and Skills Framework, although they are not intended to replace any of these.

The guidance explains that effective support for self-care requires a shift towards a supportive and empowering environment to enable people to take control. It says there needs to be an 'explicit understanding' that this signals a shift in the power relationship between staff and patients to a sharing of responsibility and rights over decision-making.

The approach underpinning self-care is based on partnerships, is non-judgemental and supportive. All seven principles (see box) apply to all health and social care staff – they should be taken and implemented as a whole.

The guidance outlines the context and expected behaviour for each principle. For principle 1, it stresses that practice is based on a shift of values from professionals knowing best to them supporting and empowering people to be in control of their needs. An example of behaviour expected from healthcare staff is that they should develop skills in supporting self-care, and a non-judgemental practice style that respects patients' rights, privacy and dignity.

To implement principle 2, staff should use communication and relationship skills that encourage and support patients to work with them to identify strengths and abilities and find solutions together. The third principle involves staff encouraging and supporting people in accessing appropriate information and, where possible, providing relevant and evidence-based information.

Principle 4 involves facilitating access to appropriate training and self-care skills development, as well as offering support to people as they develop such skills. The fifth principle means staff should ensure appropriate equipment and devices are discussed and, when appropriate, should put people in touch with relevant agencies.

Principle 6 means staff should give people advice on participation in support networks. In addition, they should promote and encourage patient/service-user involvement in planning, development and evaluation of services. The final principle on risk management and risk-taking requires staff to support people to make choices about how to manage any identified risks.

Key messages for nurses

Supporting individual empowerment and self-care may require healthcare staff to work in different ways. The guidance acknowledges that changing practice is never easy but points out that meeting the challenge of change can be both motivating and empowering. It states that using the common core principles will:

• Increase job satisfaction by helping practitioners meet patients', service users' and carers' needs and expectations;

• Support development of personalised care plans which people own and control, in partnership with healthcare professionals;

• Demonstrate practitioners' commitment to evidence-based practice;

• Provide a common language for sharing plans and information about practice outcomes with colleagues;

•  Provide practitioners with a framework to support self-evaluation;

• Support professional development.

To make the most of the principles, practitioners should:

• Ensure support for self-care is built into personal and team objectives;

• Discuss the principles with supervisors and/or line managers to ensure shared understanding of the implications for job roles and working practice;

• Set SMART (specific, measurable, attainable, realistic and timebound) development targets based on the principles and agree these with line managers;

• Be ready to plan and undertake training on the principles;

• Promote the principles to colleagues and provide peer support and/or supervision to others according to the role;

• Challenge practice which is not consistent with the principles.

The document also outlines key messages for other groups, including leaders and managers. It adds the principles should become an integral part of all education for healthcare staff.

The challenge ahead

The guidance acknowledges that redesigning services to achieve personalisation for all will require huge change in all parts of the system. While many staff already work to promote self-care, more work is needed to ensure this becomes routine practice.

As a key consideration, it is essential staff at all levels, managers, employers and commissioners in health and social care recognise the value of such change and have the skills to deliver it. Skills for Care and Skills for Health are piloting the common core principles in different contexts to gather feedback on the process of embedding them into working practice, and the lessons learnt will be shared in order to support implementation.

Conclusion

The launch of the seven common core principles demonstrates the increasing importance of promoting and supporting self-care. In order to implement this aspect of policy, nurses need to be aware of the principles and understand how they need to develop or adapt practice to support patients, service users and carers in self-care.

References

Department of Health (2007) Research Evidence on the Effectiveness of Self-care Support. www.dh.gov.uk

Department of Health (2006a) Our Health, Our Care, Our Say: A New Direction for Community Services. www.dh.gov.uk

Department of Health (2006b) Supporting People with Long-term Conditions to Self-care: A Guide to Developing Local Strategies and Good Practice. www.dh.gov.uk

Hairon, N. (2007) Evidence on effectiveness of self-care support strategies. Nursing Times; 103: 49, 21–22.

Skills for Care, Skills for Health (2008) Common Core Principles to Support Self-care. A Guide to Support Implementation. www.dh.gov.uk