{"id":975,"date":"2018-07-30T14:59:54","date_gmt":"2018-07-30T14:59:54","guid":{"rendered":"http:\/\/practicalhealthpsychology.com\/?p=975"},"modified":"2025-11-04T14:37:31","modified_gmt":"2025-11-04T14:37:31","slug":"self-regulation-from-theory-to-practice-supporting-your-patients-goals-for-change","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/cz\/2018\/07\/self-regulation-from-theory-to-practice-supporting-your-patients-goals-for-change\/","title":{"rendered":"Seberegulace od teorie k praxi: jak podpo\u0159it pacienty a jejich c\u00edle"},"content":{"rendered":"<p><strong>Stan Maes &amp; V\u00e9ronique De Gucht, Leiden University, Netherlands<\/strong><\/p>\n<p>V pr\u016fb\u011bhu posledn\u00edch desetilet\u00ed se role jednotlivce ve zdravotn\u00edm syst\u00e9mu vyvinula od \u201edodr\u017eov\u00e1n\u00ed l\u00e9\u010debn\u00e9ho re\u017eimu (compliance)\u201c, kter\u00e9 nazna\u010duje poslu\u0161nost, k \u201eself-managementu\u201c, kter\u00fd zd\u016fraz\u0148uje vlastn\u00ed odpov\u011bdnost za zdrav\u00ed i zvl\u00e1d\u00e1n\u00ed nemoci. V posledn\u00ed dob\u011b se v\u00a0tomto ohledu pokro\u010dilo k\u00a0pojmu \u201eseberegulace\u201c, tj. systematick\u00fd proces zahrnuj\u00edc\u00ed stanovov\u00e1n\u00ed si osobn\u00edch c\u00edl\u016f souvisej\u00edc\u00edch se zdrav\u00edm a\u00a0\u00fapravu chov\u00e1n\u00ed v\u00a0souladu s\u00a0t\u011bmito c\u00edli. Abychom p\u0159ibl\u00ed\u017eili tento kontinu\u00e1ln\u00ed seberegula\u010dn\u00ed proces, vybrali jsme jako doprovodn\u00fd obr\u00e1zek k\u00a0tomuto p\u0159\u00edsp\u011bvku klasick\u00e9 zobrazen\u00ed \u201eurborose\u201c (tj. hada, kter\u00fd po\u017e\u00edr\u00e1 sv\u016fj vlastn\u00ed ocas).<\/p>\n<p><!--more--><\/p>\n<p>Seberegulace prob\u00edh\u00e1 ve f\u00e1z\u00edch: (1) uv\u011bdom\u011bn\u00ed si (nutnosti) c\u00edle a stanoven\u00ed si c\u00edle; (2) aktivn\u00ed sledov\u00e1n\u00ed c\u00edle a (3) dosa\u017een\u00ed c\u00edle, jeho udr\u017eov\u00e1n\u00ed a upu\u0161t\u011bn\u00ed od c\u00edle. V\u00a0n\u00e1sleduj\u00edc\u00edch odstavc\u00edch tyto f\u00e1ze p\u0159ibl\u00ed\u017e\u00edme na p\u0159\u00edkladu Honzy, kter\u00e9ho postihla srde\u010dn\u00ed p\u0159\u00edhoda.<\/p>\n<p><strong>F\u00e1ze 1<\/strong><\/p>\n<p>V\u00a0prvn\u00ed f\u00e1zi by si m\u011bl jedinec uv\u011bdomit zdravotn\u00ed c\u00edle a nastavit si takov\u00e9, kter\u00e9 jsou realistick\u00e9 a pro n\u011bj d\u016fle\u017eit\u00e9. Honzy se m\u016f\u017eeme zeptat, co pro n\u011bj znamen\u00e1 uzdraven\u00ed. Pokud nap\u0159\u00edklad odpov\u00ed, \u017ee je pro n\u011bj d\u016fle\u017eit\u00e9 chodit do p\u0159\u00edrody se sv\u00fdm vnou\u010detem, m\u016f\u017ee si pro za\u010d\u00e1tek stanovit za c\u00edl <em>za\u010d\u00edt chodit na kr\u00e1tk\u00e9 vych\u00e1zky po okol\u00ed<\/em>. D\u016fle\u017eit\u00e9 je, aby si podobn\u00e9 c\u00edle stanovil jedinec s\u00e1m a aby byly realistick\u00e9 vzhledem k\u00a0jeho aktu\u00e1ln\u00edm schopnostem. T\u00edm se posiluje pocit <em>vlastnictv\u00ed<\/em> c\u00edl\u016f, \u010d\u00edm\u017e se oproti c\u00edl\u016fm zadan\u00fdm druh\u00fdmi lidmi st\u00e1vaj\u00ed sn\u00e1ze dosa\u017eiteln\u00fdmi. U nemotivovan\u00fdch jedinc\u016f mohou stanovov\u00e1n\u00ed si osobn\u00edch c\u00edl\u016f podpo\u0159it techniky <a href=\"http:\/\/work.chron.com\/5-principles-motivational-interviewing-1836.html\">motiva\u010dn\u00edho rozhovoru<\/a>.<\/p>\n<p><strong>F\u00e1ze 2<\/strong><\/p>\n<p>Druhou f\u00e1zi charakterizuje \u00fasil\u00ed o dosa\u017een\u00ed c\u00edle. V\u00a0t\u00e9to f\u00e1zi mus\u00ed jedinec p\u0159ekonat <a href=\"http:\/\/eprints.whiterose.ac.uk\/107519\/3\/The%20Intention-Behavior%20Gap%20R1.pdf\">zn\u00e1mou propast<\/a> mezi kognic\u00ed (nap\u0159. z\u00e1m\u011br) a \u010diny. Proto je pot\u0159eba konkr\u00e9tn\u00ed \u201eak\u010dn\u00ed pl\u00e1n\u201c, kter\u00fd stanovuje, kdy, kde a jak p\u0159esn\u011b se chovat. V\u00a0na\u0161em p\u0159\u00edkladu si Honza m\u016f\u017ee \u0159\u00edci: \u201eOd p\u0159\u00ed\u0161t\u00edho t\u00fddne za\u010dnu chodit s\u00a0man\u017eelkou do bl\u00edzk\u00e9ho obchodu v\u017edy v\u00a0pond\u011bl\u00ed, st\u0159edu a p\u00e1tek ve t\u0159i hodiny odpoledne.\u201c Podobn\u00e9 ak\u010dn\u00ed pl\u00e1ny, kter\u00e9 dostate\u010dn\u011b specifikuj\u00ed detaily, podle v\u00fdzkum\u016f podporuj\u00ed \u00fasp\u011b\u0161n\u00e9 dosa\u017een\u00ed c\u00edl\u016f souvisej\u00edc\u00edch s\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1469029212001148\">fyzick\u00fdm pohybem<\/a>, <a href=\"http:\/\/53303223.nl.strato-hosting.eu\/wp-content\/uploads\/2012\/04\/Adriaanse-Vinkers-et-al.-2011-Appetite.pdf\">zdrav\u00fdm stravov\u00e1n\u00edm<\/a> a <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/aphw.12017\">jin\u00fdmi druhy<\/a> zdravotn\u00edho chov\u00e1n\u00ed.<\/p>\n<p>P\u0159i \u00fasil\u00ed o dosa\u017een\u00ed c\u00edle nav\u00edc hraj\u00ed v\u00fdznamnou roli t\u0159i regula\u010dn\u00ed mechanismy. Prvn\u00edm z\u00a0nich je <em>zp\u011btn\u00e1 vazba<\/em>, kter\u00e1 zahrnuje proces monitorov\u00e1n\u00ed a hodnocen\u00ed postupu. Honza z\u00a0na\u0161eho p\u0159\u00edkladu tedy m\u016f\u017ee b\u00fdt po\u017e\u00e1d\u00e1n, aby si zaznamen\u00e1val svou aktivitu tak, aby vid\u011bl, zda pln\u00ed sv\u016fj c\u00edl. V\u00fdsledky je pak mo\u017en\u00e9 s\u00a0Honzou probrat a bu\u010f zreflektovat \u00fasp\u011bch, nebo zjistit probl\u00e9my, kter\u00e9 bude pot\u0159eba v budoucnu p\u0159ekonat. Druh\u00fd mechanismus zahrnuje <em>anticipa\u010dn\u00ed nebo \u201cdop\u0159edn\u00e9\u201d procesy<\/em>, kter\u00e9 se t\u00fdkaj\u00ed o\u010dek\u00e1v\u00e1n\u00ed ohledn\u011b v\u00fdsledk\u016f (nap\u0159. co si jedinec mysl\u00ed, \u017ee se stane, pokud se n\u011bjak zachov\u00e1) a p\u0159esv\u011bd\u010den\u00ed o vlastn\u00ed \u00fa\u010dinnosti (nap\u0159. zda jedinec v\u011b\u0159\u00ed, \u017ee se m\u016f\u017ee zachovat \u00fasp\u011b\u0161n\u011b). O\u010dek\u00e1v\u00e1n\u00ed v\u00fdsledk\u016f a vn\u00edman\u00e1 vlastn\u00ed \u00fa\u010dinnost jsou posilov\u00e1ny sledov\u00e1n\u00edm \u00fasp\u011b\u0161n\u00fdch p\u0159\u00edklad\u016f, pokroky p\u0159i pln\u011bn\u00ed c\u00edle a povzbuzov\u00e1n\u00edm. Praktici by tedy m\u011bli pacient\u016fm zprost\u0159edkov\u00e1vat kontakt s jin\u00fdmi lidmi, kte\u0159\u00ed \u00fasp\u011b\u0161n\u011b dos\u00e1hli porovnateln\u00fdch c\u00edl\u016f, aby t\u00edm zv\u00fd\u0161ili pravd\u011bpodobnost dosa\u017een\u00ed c\u00edle a poskytli jedinci p\u0159\u00edle\u017eitosti, jak p\u0159i pln\u011bn\u00ed c\u00edl\u016f z\u00edskat oporu. Posledn\u00edm mechanismem je <em>aktivace \u0159\u00edd\u00edc\u00edch proces\u016f<\/em>, aby neustalo \u00fasil\u00ed p\u0159i setk\u00e1n\u00ed s p\u0159ek\u00e1\u017ekou nebo konkuren\u010dn\u00edm c\u00edlem. Rozpt\u00fdlen\u00ed od vlastn\u00edch c\u00edl\u016f, nap\u0159. \u017eivotn\u00ed ud\u00e1lost, mohou m\u00edt neblah\u00fd vliv na \u00fasil\u00ed p\u0159i dosahov\u00e1n\u00ed c\u00edle. P\u0159\u00edli\u0161 pomal\u00fd postup nebo ne\u00fasp\u011bch p\u0159i dosahov\u00e1n\u00ed c\u00edle \u010dasto souvis\u00ed s negativn\u00edmi emocemi. Pokud k n\u011b\u010demu takov\u00e9mu dojde, m\u016f\u017ee se vyplatit nap\u0159. Honzovi nab\u00eddnout pomoc p\u0159i zpracov\u00e1n\u00ed t\u011bchto emoc\u00ed a vyrovn\u00e1n\u00ed se s ne\u00fasp\u011bchem, t\u0159eba t\u00edm, \u017ee se na situaci budeme d\u00edvat jako na p\u0159\u00edle\u017eitost k pou\u010den\u00ed.<\/p>\n<p><strong>F\u00e1ze 3<\/strong><\/p>\n<p>T\u0159et\u00ed f\u00e1ze zahrnuje dosa\u017een\u00ed c\u00edle, jeho udr\u017eov\u00e1n\u00ed a upu\u0161t\u011bn\u00ed od c\u00edle. Dosa\u017een\u00edm c\u00edle nic nekon\u010d\u00ed. Naopak je to nov\u00fd za\u010d\u00e1tek. Jedince m\u016f\u017eeme podpo\u0159it v tom, aby si stanovil nov\u00e9 c\u00edle a dosahoval tak dal\u0161\u00edch pokrok\u016f. Pokud se vlastn\u00ed stanoven\u00fd c\u00edl uk\u00e1\u017ee jako nedosa\u017eiteln\u00fd, je \u010dasto moudr\u00e9 od n\u011bj upustit a zvolit <a href=\"http:\/\/sci-hub.tw\/https:\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/j.1464-0597.2005.00210.x\">c\u00edl dosa\u017eiteln\u011bj\u0161\u00ed<\/a>. Honza z\u00a0na\u0161eho p\u0159\u00edkladu proto m\u016f\u017ee bu\u010f pokra\u010dovat ve sv\u00e9m aktu\u00e1ln\u00edm stanoven\u00e9m c\u00edli, nebo si stanovit c\u00edl nov\u00fd, nap\u0159. chodit denn\u011b na kr\u00e1tkou proch\u00e1zku se psem. Podpora vn\u00edman\u00e9 vlastn\u00ed \u00fa\u010dinnosti a soci\u00e1ln\u00ed opora jsou d\u016fle\u017eit\u00fdmi prediktory schopnosti udr\u017eet si c\u00edl.<\/p>\n<p>\u00da\u010dinnost intervenc\u00ed c\u00edlen\u00fdch na seberegulaci p\u0159i zm\u011bn\u011b zdravotn\u00edho chov\u00e1n\u00ed byla prok\u00e1z\u00e1na mnoha v\u00fdzkumy, a to jak u neklinick\u00e9 populace, tak u pacient\u016f s\u00a0chronick\u00fdm onemocn\u011bn\u00edm. Viz nap\u0159. <a href=\"https:\/\/openaccess.leidenuniv.nl\/handle\/1887\/13515\">redukce v\u00e1hy u pacient\u016f s\u00a0diabetem typu 2<\/a>, <a href=\"https:\/\/openaccess.leidenuniv.nl\/handle\/1887\/20846\">fyzick\u00e1 aktivita u pacient\u016f s\u00a0artritidou<\/a>, <a href=\"https:\/\/openaccess.leidenuniv.nl\/handle\/1887\/19850\">zm\u011bna \u017eivotn\u00edho stylu p\u0159i rehabilitaci u kardiak\u016f<\/a>, a <a href=\"https:\/\/openaccess.leidenuniv.nl\/handle\/1887\/31422\">vyva\u017eov\u00e1n\u00ed aktivity a odpo\u010dinku u chronick\u00e9ho \u00fanavov\u00e9ho syndromu<\/a>.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-988\" src=\"https:\/\/practicalhealthpsychology.com\/wp-content\/uploads\/2018\/07\/Screenshot-2018-07-30-16.39.36-300x260.png\" alt=\"\" width=\"492\" height=\"426\" srcset=\"https:\/\/practicalhealthpsychology.com\/wp-content\/uploads\/2018\/07\/Screenshot-2018-07-30-16.39.36-300x260.png 300w, https:\/\/practicalhealthpsychology.com\/wp-content\/uploads\/2018\/07\/Screenshot-2018-07-30-16.39.36-768x665.png 768w, https:\/\/practicalhealthpsychology.com\/wp-content\/uploads\/2018\/07\/Screenshot-2018-07-30-16.39.36-830x718.png 830w, https:\/\/practicalhealthpsychology.com\/wp-content\/uploads\/2018\/07\/Screenshot-2018-07-30-16.39.36-230x199.png 230w, https:\/\/practicalhealthpsychology.com\/wp-content\/uploads\/2018\/07\/Screenshot-2018-07-30-16.39.36-350x303.png 350w, https:\/\/practicalhealthpsychology.com\/wp-content\/uploads\/2018\/07\/Screenshot-2018-07-30-16.39.36-480x415.png 480w, https:\/\/practicalhealthpsychology.com\/wp-content\/uploads\/2018\/07\/Screenshot-2018-07-30-16.39.36.png 982w\" sizes=\"(max-width: 492px) 100vw, 492px\" \/><\/p>\n<p>Sch\u00e9ma: Cyklus seberegulace.<\/p>\n<p>Popisky:<\/p>\n<ul>\n<li>subjektivn\u00ed vn\u00edm\u00e1n\u00ed zdrav\u00ed a rizika<\/li>\n<li>motivace ke zm\u011bn\u011b<\/li>\n<li>stanovov\u00e1n\u00ed konkr\u00e9tn\u00edch c\u00edl\u016f a pl\u00e1nov\u00e1n\u00ed<\/li>\n<li>usilov\u00e1n\u00ed o dosa\u017een\u00ed c\u00edle: self-monitoring, zp\u011btn\u00e1 vazba, anticipace a kontrola<\/li>\n<li>sebereflexe, dosa\u017een\u00ed, udr\u017een\u00ed nebo upu\u0161t\u011bn\u00ed od c\u00edle a jeho revize<\/li>\n<\/ul>\n<p><strong>Praktick\u00e1 doporu\u010den\u00ed<\/strong><\/p>\n<ul>\n<li>Podporujte pacienta, aby si stanovil osobn\u00ed c\u00edl souvisej\u00edc\u00ed se zm\u011bnou v oblasti zdravotn\u00edho chov\u00e1n\u00ed (nap\u0159. ot\u00e1zkou, podle \u010deho pozn\u00e1, \u017ee se uzdravil). Takov\u00e9 c\u00edle by m\u011bly b\u00fdt konkr\u00e9tn\u00ed, v\u00fdznamn\u00e9 pro dan\u00e9ho jedince, ani p\u0159\u00edli\u0161 snadn\u00e9, ani p\u0159\u00edli\u0161 obt\u00ed\u017en\u00e9, a dosa\u017eiteln\u00e9 v ohrani\u010den\u00e9m \u010dasov\u00e9m \u00faseku.<\/li>\n<li>Pom\u00e1hejte pacientovi vytvo\u0159it si <a href=\"https:\/\/practicalhealthpsychology.com\/2017\/04\/the-power-of-planning\/\">ak\u010dn\u00ed pl\u00e1n<\/a>, a to ot\u00e1zkami typu kdy, kde, jak a jak dlouho se bude chovat konkr\u00e9tn\u00edm zp\u016fsobem ve vztahu ke zvolen\u00e9mu c\u00edli.<\/li>\n<li>Vyb\u00eddn\u011bte pacienta, aby si sestavil \u017eeb\u0159\u00ed\u010dek, kter\u00fd specifikuje snadno zhodnotiteln\u00e9 \u010di m\u011b\u0159iteln\u00e9 postupn\u00e9 kroky sm\u011brem ke spln\u011bn\u00ed c\u00edle.<\/li>\n<li>Zvy\u0161ujte pacientovu vn\u00edmanou vlastn\u00ed \u00fa\u010dinnost p\u0159\u00edklady ostatn\u00edch, kte\u0159\u00ed dos\u00e1hli srovnateln\u00e9ho c\u00edle, povzbuzujte pacienty a chvalte jejich pokroky. U\u010dte je, jak se vyrovnat s\u00a0p\u0159ek\u00e1\u017ekami a ne\u00fasp\u011bchy.<\/li>\n<li>Podporujte schopnost pacienta udr\u017eet si c\u00edl a pom\u00e1hejte jim p\u0159i reformulaci c\u00edle, kter\u00fd bude dosa\u017eiteln\u011bj\u0161\u00ed ne\u017e c\u00edl aktu\u00e1ln\u00ed.<\/li>\n<\/ul>\n<p><em>P\u0159eklad: Ren\u00e1ta \u010cerm\u00e1kov\u00e1<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Stan Maes &amp; V\u00e9ronique De Gucht, Leiden University, Netherlands Over the last decades, the role of individuals within the healthcare system has evolved from \u2018compliance with medical regimens\u2019, implying obedience; to \u2018self-management\u2019, denoting responsibility for the control of one\u2019s [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1029,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[24],"tags":[],"class_list":["post-975","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-self-regulation"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"cz","enabled_languages":["en","id","my","bg","zh","hr","cz","da","de","es","fr","gr","he","it","ja","kr","lv","lt","hu","nl","no","pl","pt","ro","ru","sk","fi","sv","tr","uk"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"id":{"title":true,"content":true,"excerpt":false},"my":{"title":false,"content":false,"excerpt":false},"bg":{"title":true,"content":true,"excerpt":false},"zh":{"title":true,"content":true,"excerpt":false},"hr":{"title":false,"content":false,"excerpt":false},"cz":{"title":true,"content":true,"excerpt":false},"da":{"title":true,"content":true,"excerpt":false},"de":{"title":true,"content":true,"excerpt":false},"es":{"title":true,"content":true,"excerpt":false},"fr":{"title":true,"content":true,"excerpt":false},"gr":{"title":true,"content":true,"excerpt":false},"he":{"title":true,"content":true,"excerpt":false},"it":{"title":true,"content":true,"excerpt":false},"ja":{"title":false,"content":false,"excerpt":false},"kr":{"title":false,"content":false,"excerpt":false},"lv":{"title":true,"content":true,"excerpt":false},"lt":{"title":true,"content":true,"excerpt":false},"hu":{"title":false,"content":false,"excerpt":false},"nl":{"title":true,"content":true,"excerpt":false},"no":{"title":false,"content":false,"excerpt":false},"pl":{"title":true,"content":true,"excerpt":false},"pt":{"title":true,"content":true,"excerpt":false},"ro":{"title":true,"content":true,"excerpt":false},"ru":{"title":true,"content":true,"excerpt":false},"sk":{"title":true,"content":true,"excerpt":false},"fi":{"title":true,"content":true,"excerpt":false},"sv":{"title":false,"content":false,"excerpt":false},"tr":{"title":false,"content":false,"excerpt":false},"uk":{"title":true,"content":true,"excerpt":false}}},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts\/975","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/comments?post=975"}],"version-history":[{"count":31,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts\/975\/revisions"}],"predecessor-version":[{"id":4627,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts\/975\/revisions\/4627"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/media\/1029"}],"wp:attachment":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/media?parent=975"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/categories?post=975"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/tags?post=975"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}