Page 12 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 1
From acute to chronic illness
In the traditional care delivery model, a doctors’ main job was to respond rapidly and efficiently to situations requiring immediate medical care. The focus was on the definition of the problem and the initiation of treatment. Since the full clinical course usually took only a short amount of time, there was little need for the patient to develop any disease-related skills and the patient’s role was largely passive [1]. Nowadays, however, the majority of patients suffer from chronic disease(s), requiring a completely different relationship between patient and healthcare professional. The patient needs to be the manager of his own healthcare and the healthcare professional fulfils a coaching role [2]. The following metaphor nicely illustrates the position of chronically ill patients and their healthcare professionals:
‘Living with chronic illness is like flying a plane. If the plane is flown well, one gets where one wants to go. If it is flown badly, one either crashes or lands shakily in the wrong airport, reluctant to ever leave the ground again. The patient must be the pilot, because the other possible pilot, the health care professional, is only in the plane a few hours every year, and this plane rarely touches ground [1].’ Patients have to become more independent and perform certain care tasks themselves. However, this does not mean that patients should be left to fend for themselves. A new task for healthcare professionals is to assure that their patients are ‘skilled pilots’, by giving them the confidence and skills to manage their condition[1]. Patients managing their own condition is often referred to as self- management.
Self-management and self-monitoring
There are several definitions of self-management, but the one most often cited comes from Barlow and colleagues: Self-management refers to the individual’s ability to manage symptoms, treatment, physical and psychological consequences and life style changes inherent in living with a chronic condition. Efficacious self-management encompasses the ability to monitor one’s condition and to effect the cognitive, behavioural and emotional responses necessary to maintain a satisfactory quality of life[3]. In this definition, monitoring one’s condition is considered an essential element of self- management. Self-monitoring in the context of chronic illness has been defined as a patient undertaking one or more of the following activities (i) self-measurement of vital signs, symptoms, behaviour or psychological well-being, (ii) self-interpretation of self-measured data; or (iii) self- adjustment of medication, treatment, lifestyle or help-seeking behaviour as a result of self-awareness or self-interpretation[4, 5]. Patients can self-monitor by using highly advanced measurement devices that can sometimes even replace laboratory analysis, but one can also self-monitor by keeping a diary