Last week I read an article about “patient activation” with some amusement. Activation sounded like batteries. Did patients need a couple of Triple As inserted into the soles of their feet to get involved in their own health care?
The article defined patient activation as “understanding one’s own role in the care process and having the knowledge, skills, and confidence [italics mine] to take on that role.”
Chuckling to myself, I thought of the mid-seventies when I was a student in an RN-to-bachelor’s degree program. My friend and I were taking a nursing concepts course and learning about theories of nursing for the first time. In Dorothea Orem’s1 developing conceptual model of self care, we learned about patients’ self-care agency—agency referring to the knowledge, motivation, and skills required for them to meet their own health care needs.
Sitting in the back row of the class, my friend and I dissolved into giggles. Agency reminded us of insurance, not nursing. After all, we’d been nurses already for fifteen years and had functioned just fine, thank you, without knowing a thing about our patients’ self-care agency. We had learned and practiced nursing under the medical model, a model based on body systems, medical diagnoses, and physician-ordered treatments.
In those days we even had to call the doctor for an order to shampoo a patient’s hair.
In the interim, however, nursing scholars had made significant advancements in formulating our own theories of nursing that described the art and science of nursing, enabling us as a profession to think within a nursing framework. Simply put, instead of “doing physician-ordered treatments to” our patients, we adapted the well-established scientific method into a five-step format called the nursing process, to work collaboratively with our patients to (1) assess their nursing care needs, (2) make nursing diagnoses, then (3) plan, (4) implement, and (5) evaluate their care, with the goal of assisting them to achieve an optimal level of self care.
It was an exciting time for nursing. A drastic change in thinking from working dependently under physicians to working collaboratively with them, and, in some cases, independently.
I digress! Now I’m reading the definition of “patient activation” and am riveted to my nostalgic bookshelves where my old textbooks have found a permanent home. I find three editions of Orem’s Nursing: Concepts of Practice and a user-friendly “primer for application of the concepts” that I used later in my teaching. I read again about knowledge, motivation, and skills. What goes around comes around, comes to mind. And I’m proud of the early nursing scholars for their seminal theoretical work.
But, no doubt If I were sitting in a class today learning about patient activation, batteries would come to mind, and I’d be back to giggling. However, it’s not a laughing matter. According to the article, “patients who are actively involved in their health and health care achieve better health outcomes, and have lower health costs than those who aren’t.”
Applying this notion to my scabies story of last week, I did not need batteries to activate me to seek a doctor’s help, the relentless intense itching did that on its own. No doubt seeing my internist, then a dermatologist promptly led to a quick diagnosis and treatment so that my symptoms are mostly gone and my costs have been kept to a minimum.
I bring up this experience because in my Web search on itching, I read dozens of posts by people suggesting a myriad of home remedies to quell the scratching. I read of people being too embarrassed to see a doctor. I read of months, even years, of undiagnosed, probably under-treated, bouts of itching causing much distress.
I think now about how desperate I was for relief over the three days between my doctors’ visits. I think of how much time I spent searching the Web and scanning shelves at Walgreen’s for products that might kill off the invaders of my body and sanity. And I think how my anxiety would have been compounded if I didn’t have access to health insurance.
As it was, I had insurance and the knowledge, motivation, and skills to seek the proper treatment. Without these, it’s highly doubtful I would have better health outcomes and lower costs than people who don’t have these resources.
Read the article yourself about the concept of patient activation, and see how it applies to you and your relationship with your health care providers. Get activated. Get engaged in your own health care. If we all do this, and if our health care providers work with us, we’ll have better outcomes. Plus, we’ll know we’re doing our part to be as healthy and happy as we can be, while, at the same time, helping to contain our ever-increasing health care costs.
Read an additional response article by Jacob Molyneaux, Senior Editor at AJN Off the Charts.
1Orem, D. (1971). Nursing: Concepts of Practice. New York: McGraw-Hill.