Creative Thinking, Critical Thinking, and Problem Solving for

Patient Navigators

Community of Practice CallRibbon Consulting Group

August 28, 2017

Objectives

1. Review patient navigator roles and responsibilities

2. Explore critical thinking, creative thinking, and problem-solving concepts.

3. Explore how critical thinking and creative thinking can help with problem-solving via a series of activities.– Mapping– Brainstorming– Role-Play

PN Role and Responsibilities

Objectives (or core elements)

• Assist in the retention of patients in care in order to achieve positive health outcomes.

Indicators (or evidence)

• Patients are in care by evidence of:1. Medical visits attended

2. Medication adherence

3. Viral suppression

Goal

1. Implementation & maintenance of the PN intervention

2. Conduct six (6) educational sessions3. Serve as a member of a multi-

disciplinary healthcare team4. Utilize clinical supervision5. Transition patient to case

management after six (6) months

PN Role and Responsibilities

Challenge #1

• Engaging & Retaining Patients– Assessment

• Patient File

– Outreach

– Communication

• Conversational Engagement

– Interview

– Intake

– Acuity Tool

• Motivational Interviewing

• Motivational Support

Challenge #2

• Addressing Basic Needs– Shelter

– Water & Food

– Transportation

– Support

– Safety

PN Role and Responsibilities

Challenge #3

• Educational Sessions– Health Literacy: HIV

– Health Literacy: Labs

– Adherence

• Communicating with Providers

– Stigma and Disclosure

• HIV criminalization

– Substance Use

– Mental Health

Challenge #4

• Self-care– Developing and implementing

a self-care plan

• Vicarious trauma

• Disappointment

• Loss

Creative Thinking, Critical Thinking, and Problem Solving

• Critical thinking focuses on step-by-step, linear processes aimed at arriving at the (best) answer.

• Creative thinking begins with possibility, multiple ideas, and suspending judgement.

• While these two kinds of thinking work in different ways, they actually support one another and aim at the same ultimate goal, which is to solve a problem.

• At the beginning of the problem-solving process, creative methods are used to examine the problem, generate ideas, and make associations.

• Then analysis and judgment are brought into play, and the possibilities are analysed for a possible solution.

The BrainCritical Thinking & Creative Thinking

8

Critical and Creative ThinkingStages in Problem Solving

Critical and Creative Thinking

Critical Thinking• Requires you to consider:

– Question: what is being asked?– Purpose: why do I want the

answer?– Point of View: where do I stand in

looking at the question?– Information: what data is available

to me?– Concepts: what ideas are being

developed & explored?– Assumptions: what am I taking for

granted?– Inferences: what conclusions am I

drawing?– Consequences: what are the

implications?

Critical Thinking

• Requires you to consider:– What is it about this situation

that is creating a challenge for me?

– Can I come up with a variety of ideas to address this challenge?

– Did I consider several alternatives before acting?

Problem Solving

What is a Problem?

• A problem arises when an individual has a goal but does not know how this goal is to be reached.

• A problem exists whenever one cannot go from the given situation to the desired situation simply by action.

What is Problem Solving?

• Problem Solving is the process of working out or discovering how to reach such a goal.

Problem Solving

• The IDEAL Model

–Identify the problem.

–Define the problem.

–Explore alternative approaches.

–Act on the best strategies.

–Look back to evaluate the effects.

Case Study

• Debra is a 40-year-old woman who was diagnosed with HIV four-years ago. She decides, after her first visit that she is not ready to deal with this situation. After hearing from you she comes in to learn about the intervention. She is now considering starting HIV care and treatment but only if she can get over her fears about HIV and concerns about people finding out she is HIV-positive.

• This change of heart comes about because she has been experiencing difficulty in breathing and night sweats. She developed a persistently high fever and now is extremely dehydrated. This health scare eventually led her adult daughter to take her to the emergency room (ER). She tearfully decides to disclose her HIV status to the emergency room staff but not her daughter. She also discloses that she is diabetic and that she does not take her diabetic medication on a regular basis.

• The ER doctor decides to run a battery of tests, including an HIV test to confirm her HIV-positive status. After receiving the laboratory results, the ER doctor informs her, in addition to confirming her HIV-positive status, that she has a severe sinus infection. In addition, she is informed that her CD4 Count (or T-Cells) has dropped from 350 T-Cells to 150 T-Cells and her viral load is now in the millions of copies.

• Debra goes into an emotional tailspin because she now knows her health condition is critical. The ER doctor assures her that she is not dying but needs to make a decision about starting HIV treatment. This is not an easy decision for her because she has not disclosed her HIV status to anyone else. You see Debra’s family is well know in the community and she feels that disclosing her HIV status will not only shame her but will also bring shame to her partner, family, and her friends.

• Additionally, she is afraid that her mother will revert to treating her badly like she did when she found out that Debra was using drugs, which caused her to lose her job and children.

Problem-Solving Techniques

• Five activities will be employed to explore how to implement the IDEAL Model to address patient challenges:

– Preparation

– Mapping

– Brainstorming

– Role play

– Evaluation

Problem-Solving Techniques

• Identifying the problem

– Tips for Preparing for a Patient Session

• Check notes from previous encounters

• Check progress notes from other providers (if have access to these)

• Check latest labs

• If possible, meet with team to discuss progress of particular patients (during team huddles) for patients who are having difficulty engaging in care or are dealing with particularly difficult issues at the time.

Problem-Solving Techniques

• Defining the problem

– Mapping

• Outline the success and challenges the patient is facing– WHAT’S POSSIBLE: Creative thinking

– WHY IS IT POSSIBLE: Critical thinking

– HOW IS IT POSSIBLE: Problem solving

Problem-Solving Techniques

• Exploring alternative approaches

– Brainstorming

• Explore reasons why patients might be having a difficulty with a particular issue

Problem-Solving Techniques

• Act on best strategies

– Role-Play

• Practice sessions on how to effectively deliver the educational sessions

Problem-Solving Techniques

• Look back to evaluation the effects

– Assessing and Monitor Progress

• Ask questions

• Ask patient to repeat what they hear

• Review patient records – Medical appointment

– Review lab work to assess medication Adherence

Demonstration

• Educational Session

– HIV, the Viral Life Cycle & Understanding HAART and Adherence

• TIP: An alternate way of delivering this session is to show the “HIV Illustrated Man” video first then conduct the session.

Role-Play

• HIV, the Viral Life Cycle & Understanding HAART and Adherence

– Having the conversation

• Decide what to cover– Validate and thank them for their response(s)

• Based on the response(s) to the question(s) decide what else needs to be covered with the patient

• Ask the patient to share with you what they heard– Validate and thank them for their response(s)

• Inform them of the next step in the process

Thank You!

• Any final questions or comments?

• Contact

– Linda H. Scruggs at lscruggs@rcg3.com

– Vanessa Johnson at vjohnson84bj@gmail.com