AS@W
PCHC Positive Coping with Health Conditions
Solving Problems

“I copy out all my medications and hand it to every doctor I see. I got my pharmacist to do a printout of all my medications; it fits in my purse.” *

* Quote from a person in a chronic illness support group.

The steps toward Solving Problems are:

  1. Choose a problem
  2. Think of actions to help solve the problem
  3. Compare these actions
  4. Pick the best one
  5. Make an action plan
  6. Evaluate
  7. Move on

Why Is this Important?

Health conditions create a number of problems. These include managing symptoms, getting to medical appointments, keeping track of medications and handling job difficulties resulting from the health condition. Sometimes, your usual way of handling things isn’t enough. In that case, you might feel overly stressed and begin to experience low mood, anxiety or irritability.

Stress symptoms make it harder to solve problems. Someone who feels depressed might have trouble concentrating or thinking of solutions; someone who is worrying in circles might have trouble weighing the alternatives and making a choice; and someone who is angry might have difficulty thinking calmly about the situation.

How Can I Become Better at Solving Problems?

When you’re dealing with the problems created by a health condition, use the step-by-step problem-solving method we’re going to describe. The steps look simple, but research has shown that this method is very helpful for people dealing with stress.

1

Choose a Problem

The first step is to choose a problem. It may be difficult to identify the problem you want to start with. Sometimes it feels like your life has become one huge problem. Or the health condition itself may seem like the only problem – but curing the health condition probably isn’t within your power. Here are some examples of problems you might start with:

  • Handling symptoms of the health condition
  • Keeping track of medication
  • Remembering self-care activities
  • Getting information about your
    health condition

It’s best to begin by choosing one of the smaller problems that is happening now. You can move up to larger problems later. Try to be specific. For example, “I feel I’m falling apart physically” isn’t specific; it’s not clear what the problem is. It would be more specific to say, “I become breathless doing everyday activities” – this makes it clear what’s going wrong and what you want to change.

PencilThe problem you choose is:

 

 

2

Think of Actions to Help Solve the Problem

Write down three actions you could take to help solve the problem. Don’t try to decide yet which one is best; just come up with different actions you might carry out. Don’t worry if you tried something before and it didn’t work – situations change. And don’t worry whether the actions will solve the problem completely – your aim now is to be doing something useful, not to fix the whole problem. There aren’t many problems you can solve completely with one action. But there are many actions that will take you a few steps closer to a solution. If you have a financial problem, for example, then your first action could be to gather the paperwork. Just gathering the papers won’t solve the problem, but it will take you closer to a solution. The important thing is to get started.

Below is an example. It was done by Kathy, a teacher who was diagnosed recently with kidney disease.

The Problem

Possible Actions

I don’t really understand what this condition involves. I was so anxious when my doctor gave me the diagnosis that I couldn’t take in much of what she said – I’m not sure what exactly these different medications are for. When I visit my doctor, I feel so nervous that it’s hard to remember what she tells me.

  1. Ask my sister to come along to my next appointment so she can help me remember.
  2. Look up information on the Web.
  3. On my next visit, use a Medication Information Sheet to keep track of
    what my physician tells me about medication.

 

Now write out three actions you might take to deal with the problem that you identified.

PencilYour Problem:

 

 

PencilPossible Actions:

1.

 

 

2.

 

 

3.

 

 

3

Compare These Actions

Consider which of these actions is most likely to help with the problem. Look at the advantages and disadvantages of each one.

This is what Kathy wrote:

Possible Actions

Advantages

Disadvantages

Ask my sister to come to my next appointment so she can help me remember.

  • It would be helpful to have another person to hear the information and ask
    good questions.
  • My sister told me that she wants to be helpful.
  • I don’t want to rely on others to gather information for me.
  • I want to learn
    how to manage my
    own healthcare.

Look up information on
the Web.

  • There are lots of health websites that give information about my illness and its treatments.
  • I don’t have to leave the house to learn about
    these things.
  • I’ve been told that not all websites have reliable information, and I can’t really tell the difference.
  • Some of the websites I’ve found are from other countries and the medication names
    are different.

Use a Medication Information Sheet to keep track of what my physician tells me about medication.

  • Filling in the information sheet would help make
    sure that I ask the
    important questions.
  • I would have the information written down for reference.
  • Maybe my doctor will be impatient with me for taking time to
    ask questions.

PencilNow it’s your turn to look at the advantages and disadvantages of the actions you identified:

My Possible Actions Advantages Disadvantages

1.

 

 

 

2.

 

 

 

3.

 

 

 

4

Pick the Best One

Look over the advantages and disadvantages of each action and decide which one is best (or perhaps least bad). There are no fixed rules for making this choice – the only rule is that you must choose one of the actions so that you can begin. Look over the possibilities, think about the good and bad points of each, and then just pick one. It should be an action that takes you partway towards a solution. Give yourself a limited period of time to make this decision so it doesn’t drag on. Remember, if you start to move in one direction and discover that it really doesn’t work, you can always try another action.

Kathy, the teacher with kidney disease, decided to go with her third action: Use a Medication Information Sheet to keep track of what my physician tells me about medication. (A Medication Information Sheet appears at the end of this workbook.) All of her possible actions had some advantages but this one seemed best. She was nervous about how her physician would react to helping her fill in the form, but she decided it was worth the risk.

Which of your three possible actions do YOU choose?

PencilMy Chosen Action:

 

 

 

5

Make an Action Plan

Now that you’ve chosen an action, you can make a plan to start doing it. Your action plan says exactly what you’re going to do in the next week or two. It gets you started on your chosen action.

Your action plan should be:

Specific

What you need to do should be very clear. Bad example:Get in shape.Better example:Phone the community centre to find out whether they teach yoga.”

Realistic

Even if you don’t feel any better in the coming week than you did last week (even if you feel a little worse), you could do it anyway. It’s better to succeed at a small action plan than to fail at an overly ambitious one. Bad example:For my first time out, run a marathon.Better example:Walk one block, three times a week.” Keep in mind that health conditions and low mood slow you down and make things more difficult. Your plan should be easy enough to be achievable even if you feel low in energy and mood. Sometimes the thought of starting a new activity can seem overwhelming. In that case, try setting the goal of gathering information related to the activity (for example, “Find out what exercise activities are available at the community centre” rather than “Start working out every day”).

Scheduled

You should have a clear idea when and how you are going to carry out your action plan (for example, “Take a walk Thursday evening for 15 minutes” is better than “Walk more”). Try setting a plan that would be realistic to do this week. Decide how often and for how long you’ll do the action plan, and when you’ll do it.

In our example, Kathy’s action plan was to print off a copy of the Medication Information Sheet and then set an appointment with her family physician to fill in as much as possible about her current medications. She let the medical assistant know why she wanted this appointment, so enough time could be set aside. Kathy realized that some of the information would have to wait until she next saw the specialist.

Back to your action:

PencilWhat’s your exact action plan for the next week or two?

 

 

 

 

6

Evaluate

Come back to this section when the set time for your action has passed or when you have carried out your action plan. Ask yourself: What was the result? What did I learn?

Here is the outcome of Kathy’s action plan: her family doctor was pleased to help fill in the form; Kathy got the information she needed; and she kept the information in a special folder. She learned that a Medication Information Sheet is a good way to keep track of health information. Now, whenever her family doctor or specialist makes changes in her treatment, she continues to update the information form.

Back to your action plan:

PencilWhat was the result? What did you learn?

 

 

 

 

If you are feeling discouraged, you’ll be tempted to focus on failures and things you haven’t done, instead of congratulating yourself on your progress. If you succeeded at your action plan, stop and make yourself think about that success. Focus on the fact that you took action, even if the problem isn’t completely solved. Give yourself credit. You deserve it! Praising your own accomplishments makes it more likely that you’ll continue to work on solving problems. Praising what you’ve done is good for you and helps you to keep dealing with challenges.

7

Move On

Use the experience you’ve gained to plan your next step. You have three options:

  1. Keep going. You might keep on with what you’ve been doing (if it’s working) or make it a bit more challenging. Example: Kathy continued updating her Medication Information Sheet whenever changes were made by her treatment team. Many action plans for health conditions continue over the long term.

  2. Revise your plan and try again. If the plan didn’t work out as you expected, you might try to modify it. Example: You set the plan of walking ten blocks every day, but find this exhausting, so you revise the plan to “five blocks every second day.”

  3. Take a new approach. Perhaps you learned something useful from your first effort that suggests another way of handling the problem. Example: Let’s say Kathy found it difficult to fill in the medication form because appointments with the specialist were short – so she asked her sister to join her at those appointments and help to fill in the form.

PencilBased on your experience so far, what is your next step?

 

 

 

 

clockKeep working on this problem in a step-by-step manner. Keep track of your efforts. And keep reminding yourself about the progress you make.

Solving Problems – Remembering Self-Care Activities

If you’re having difficulty following your medication or self-care schedules, maybe forgetting doses or missing self-care activities, here’s a way to get on track.

  • Ask yourself – When will I be taking the medication or doing the self-care? This might be at a particular time of day or when you are already planning to do another activity. For example, one patient arranged to take her medication just before she took her dog out for a walk every day.
  • Take a few moments to close your eyes and picture yourself taking the medication or doing the self-care activity at the scheduled time. Imagine what you are doing just before taking the medication and where you are doing it: What do you see around you? What other things are happening? Who is nearby? In your mind, put yourself into each of the situations where you’re going to be taking medication or doing self-care. Imagine the situation, the sights and sounds, as clearly as possible. Imagine yourself taking the medication in the correct amounts or doing the activity as directed.
  • Write down what you pictured. Write a description of the situation around you as you imagine taking your medication or doing self-care.
  • Write down a rule saying when and where you are going to take the medication or do the self-care activity.

Examples:

  • When I am about to walk the dog in the evening, I will take my medication.
  • At noon, I will go into the kitchen where I keep my digipen and test my blood.
  • Post this rule someplace where you will see it often and be reminded – maybe place sticky-notes where you will be sure to notice them.

JeanSolving Problems:

Helene’s Story

Helene was diagnosed with diabetes when she was 65. She hadn’t thought much about diet or exercise before, although she realized her weight had been increasing. It was a shock when Helene’s physician gave her the diagnosis of diabetes. The educational material told her that she would have to test her blood sugar twice a day so that she could modify her eating and keep her blood sugar at a safe level.

At first Helene was careful with self-care, testing her blood sugar twice a day and then adjusting her food intake. After a few months, the illness seemed to be under control – her blood sugar was within the safe range. She began to skip some of the blood tests. Over the next year, she gradually became less likely to do the tests, until she was hardly checking her blood sugar at all. A few times she tested her blood sugar level and it came back as too high. She promised herself that she would deal with it, but somehow this never happened. There were lots of other things to keep her busy and she didn’t feel terrible (though she had low energy). Mostly, she really disliked the blood testing. It felt unpleasant and it reminded her of the diabetes, which she didn’t like to think about.

One day, while preparing lunch, Helene passed out. She was rushed to the emergency room and told that her blood sugar was far too high – she was sent home with strict instructions to get her diabetes under control. She visited her family doctor, who was concerned and frustrated that she hadn’t been doing self-care. The doctor referred her to a support group run by the local Diabetes Society. Also, seeing how tense she was and realizing that anxiety was getting in the way of self-care, the physician gave her a copy of this workbook.

Helene was frightened by the emergency visit and the warning from her physician. She attended the diabetes support group and found it helpful to hear from others dealing with the same problem. She got suggestions for building self-care into her daily life. For example, one of the group members suggested that she place a sticky-note by her bed reminding her to do her morning blood test and another next to the front door reminding her to do her afternoon test.

Helene imagined herself in the situation where she would do her morning test, then imagined herself in the situation where she do her afternoon test. By mentally rehearsing this self-care behaviour, she made it more likely that she would remember it.

With these strategies and the support of her diabetes group, Helene was able to build blood testing and dietary changes into her life. This made a big difference in her control of the diabetes and she felt less worried.

JeanSolving Problems:

Vikram’s Story

Vikram developed breathing problems when he was 25. He had noticed earlier that he would be out of breath when playing sports, but the problem became a lot worse in his 20s. He visited his family physician, who diagnosed asthma. Two medications were prescribed: a corticosteroid inhaler to reduce lung inflammation and a bronchodilator to open up passages in his lungs so that more oxygen could be absorbed. The doctor spent half an hour explaining asthma and how to use these medications. But hearing about his illness made Vikram very nervous. While the doctor was explaining, Vikram couldn’t concentrate and he missed a lot of information. He left the office with his prescriptions, filled them at the pharmacy and felt reassured. At the same time, he wasn’t entirely sure why there were two types of medication.

Vikram decided to carry the corticosteroid inhaler with him in case he started wheezing. But when he did have an asthma attack, this inhaler wasn’t effective. He then tried the bronchodilator and it worked better – it stopped the wheezing quickly. So he relied mainly on the bronchodilator.

Vikram’s symptoms got worse over the next six months. He was wheezing and panting frequently – every week or two he would have an asthma attack, which frightened him. Even though he increased his use of the bronchodilator, he was feeling increasing impact from his health condition. He was more anxious and felt less able to do physical activity.

Finally, he went back to his family doctor. The doctor realized that Vikram was using the medication incorrectly. He gave Vikram a copy of this workbook, suggesting that Vikram use the Medication Information Sheet (at the back of the book) to make notes. The physician gave him this information:

Medication

Why do I need it?

When should I take it?

Corticosteroid type

It helps to prevent asthma symptoms – it’s called a Controller

Every day

Bronchodilator type

It helps to relieve symptoms – it’s called a Quick Reliever

When you have asthma symptoms like wheezing

The doctor also recommended that Vikram read the section on Remembering Self-Care on page 50 in this workbook.

Eventually, Vikram got into the habit of using the medications correctly and according to schedule. His asthma symptoms caused him much less trouble. He was less anxious about the possibility of an asthma attack and became more physically active. His life was better. Of course, he had to keep up the self-care program, but this seemed a small price for avoiding asthma attacks.