Initial signposting

On discussion with Jean and Hilary, Fiona identified the following issues:

Thought Bubbles:

• Chest Pain – education, community pharmacy
• Inactivity – education, physiotherapy
• Medication adherence – education, community pharmacy
• Lost confidence – education, social work, community OT, physiotherapy
• Isolation – social work, community OT, physiotherapy
• Carers misconceptions – education,

Sign posts are: education, community pharmacy, physiotherapy, social work, community OT

Box under signpost with further info

• CP & Medication adherence – Fiona will provide further education and reminder for Jean about the advice of how to use her GTN spray, including advice about compliance with her Secondary Prevention medications and the need for her to attend PN for bloods and BP check to ensure up-titration of medications to evidence based dosages. Fiona suggests referral to community pharmacist for a blister pack. Jean relieved at suggestion to help her remember her tablets.
• Inactivity & lost confidence – further education about pacing and goal setting activities. Fiona makes a suggestion to Jean that she will refer her to a physiotherapy colleague for home based exercises / exercise DVD and also refer to community OT for assessment of extra handrail on stairs or any other aids to increase confidence and activity. Jean receptive to offer of help.
• Isolation – need to enable Jean to increase strength and stamina through her exercises with physiotherapist so she can return to her regular tea dances with friends. SW referral to facilitate befriending and volunteer drivers (over 65s) to transport her to tea dance. Jean excited at prospect of seeing friends again.
  Consider extra social support for shopping and meal preparation in the short term and review. If weight continues to fall, referral to community dietetic service for high calorie dietary advice suitable for person with diabetes.
• Misconceptions – Being able to identify and reframe misconceptions is a skilled task and is informed by the principles of Health Behaviour Change. It is important to build rapport and do not dismiss misconceptions outright. Rather, explore where the misconception has come from and ask permission to give some further information, then elicit their thoughts about it i.e. elicit-provide-elicit.
  It is important to listen to these common misconceptions as if they are not addressed and recognised, can lead carers to demonstrate anxiety.