Addressing Client Centered Concerns

Addressing client centered concerns requires the clinician to establish a collaborative relationship where the client is ultimately in control.  Implementing a self-management treatment plan, utilizing the 5 A approach; Assess, Advise, Agree, Assist and Arrange can be helpful (Registered Nurses’ Association of Ontario, 2010, pp. 25–44).

Assess involves establishing a good rapport with the client, screening for depression, as well as assessing for the readiness for change (Registered Nurses’ Association of Ontario, 2010, pp. 27–32).  A client’s readiness for change has been conceptualized as stages:

• Precontemplation (not thinking about changing)
• Contemplating (considering the benefits and costs of change)
• Preparation (making small changes)
• Action (taking a definitive action)
• Maintenance (sustaining the change), and
• Relapse (a normal part of the change process)
  (Registered Nurses’ Association of Ontario, 2010, p. 30).

By understanding the client’s readiness to change, the clinician can intervene appropriately. For clients in the contemplating stage, the clinician can help the client weigh the advantages and disadvantages of the change.

In the second step, the clinician advises the client, providing specific information on the client’s condition, treatment possibilities and expected outcomes.  Key to this step is providing information directly relevant to the client’s situation and context (Registered Nurses’ Association of Ontario, 2010, pp. 33–39).

In the next step the clinician and client collaboratively set goals (Registered Nurses’ Association of Ontario, 2010, p. 40).  Goals are set both on the client’s interest and their confidence in changing a specific behaviour. Jointly developing an action plan that the client can follow empowers the client to take charge of their health and make informed lifestyle choices.

Once the goals and action plans have been established, the role of the clinician is to assist the client by helping them identify and overcome any barriers (Registered Nurses’ Association of Ontario, 2010, pp. 41–43). Lastly, the clinician arranges any follow up appointments required. Regular follow up has been shown to help individuals maintain lifestyle changes (Registered Nurses’ Association of Ontario, 2010, p. 44)

Ultimately through examining the factors contributing to the client’s quality of life, as well as their lifestyle helps the clinician empower the client to move towards best practices to manage their chronic wound.