Defining Problem 3/7/2019

Learning Experience Design | Spring 2019

After visiting UPMC Passavant and talking to TC, our team gained more in-depth knowledge of readmission. Now, we need to narrow down the project scope and define the problem statement by 5W1H (Who/When/Where/Why/What/How)

Who

Stacie shared this article Five Things I Wish I’d Known Before My Chronic Illness from the New York Times a few weeks ago. The patient in this article has IBD (Inflammatory bowel disease). It is a disease that could only be maintained but not cured. Having this disease means that patient need to adopt a major lifestyle shift (especially eating) for the rest of his life.

When / Where

We have briefly think about the patient’s journey and learn from the article as well. The timing might include visiting the doctor, patient room with the nurse, discharge to other facility and home with family members or friends.

Some learnings might also happen in the digital space such as MyUPMC.com or patient forum.

Why

I think there are two points about why it is important. First of all, the cause of this disease is still unknown and it is an incurable. The patient needs to deal with it for the rest of his life. Most patients find it difficult to fully embrace the situation directly. We believe that it is important to shorten the rejection period so that the care providers could provide support more efficiently.

Secondly, since the patients need to fundamentally change his eating style. It is a great challenge in between behavior change and learning. As a result, it is a place worth exploring.

Reference

Below is the treatment reference (link)

Lifestyle and home remedies

Sometimes you may feel helpless when facing inflammatory bowel disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

Diet

There’s no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.

It can be helpful to keep a food diary to keep track of what you’re eating, as well as how you feel. If you discover some foods are causing your symptoms to flare, you can try eliminating those foods. Here are some suggestions that may help:

• Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas improve by limiting or eliminating dairy products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help as well.
• Try low-fat foods. If you have Crohn’s disease of the small intestine, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestine, making your diarrhea worse. Try avoiding butter, margarine, cream sauces and fried foods.
• Take care with fiber. If you have inflammatory bowel disease, high-fiber foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn.
• Avoid other problem foods. Spicy foods, alcohol and caffeine may make your signs and symptoms worse.

Other dietary measures

• Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
• Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
• Consider multivitamins. Because Crohn’s disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.
• Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Smoking

Smoking increases your risk of developing Crohn’s disease, and once you have it, smoking can make it worse. People with Crohn’s disease who smoke are more likely to have relapses and need medications and repeat surgeries.

Smoking may help prevent ulcerative colitis. However, its harm to overall health outweighs any benefit, and quitting smoking can improve the general health of your digestive tract, as well as provide many other health benefits. Nicotine patches have been used to treat ulcerative colitis, but the results have been disappointing.

Stress

The association of stress with Crohn’s disease is controversial, but many people who have the disease report symptom flares during high-stress periods. If you have trouble managing stress, try one of these strategies:

• Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that’s right for you.
• Biofeedback. This stress-reduction technique may train you to reduce muscle tension and slow your heart rate with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
• Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. You can take classes in yoga and meditation or use books, CDs or DVDs at home.

Coping and support

IBD doesn’t just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, it can be difficult to be out in public. All of these factors can alter your life and may lead to depression. Here are some things you can do:

• Be informed. One of the best ways to be more in control is to find out as much as possible about inflammatory bowel disease. Look for information from reputable sources such as the Crohn’s & Colitis Foundation of America (CCFA).
• Join a support group. Although support groups aren’t for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among others with IBD.
• Talk to a therapist. Some people find it helpful to consult a mental health professional who’s familiar with inflammatory bowel disease and the emotional difficulties it can cause.

Although living with IBD can be discouraging, research is ongoing, and the outlook is improving.