By Stuart Fisk, RN, CRNP, Director, Center for Inclusion Health, Allegheny Health Network, and Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse, Health Learning, Research and Practice, Wolters Kluwer
The evolution of today’s care model from the traditional episodic/disease or “sick” care model to one of more sustainable value-based wellness, continues. The industry is currently building on the success of earlier strategies aimed at chronic disease management, taking performance to the next level by advancing wellness models to focus on early intervention to minimize the potential for disease onset.
Central to these advancements is the proactive outreach tactics that bring clinicians and patients together as partners in care. As wellness models mature, the role nurses are playing naturally increase in importance due to their proximity to patients. Simply put, nurses are uniquely positioned to effect positive change as the healthcare professionals who are the most skilled at blending the “art” and “science” of care and delivering it to their patients. Consequently, healthcare organizations are best positioned for success when they equip nurses with the best resources for blending critical thinking skills with the latest evidence to empower patients towards healthier lifestyles.
Wellness: Broadening the Boundaries of Care
To realize the efficacy of wellness, providers must move outside the traditional boundaries of caring for patients within the four walls of a traditional acute care facility, and into the community at large to reach their most vulnerable populations. Strategies for helping patients best manage chronic diseases are an important part of this equation, as are tactics that can help the most at-risk patients make better choices before long before they contract an illness and require high-cost interventions from the healthcare system.
For example, the disabled, low income/homeless, and the very young/very old are groups that often experience greater risk factors, less access to care, and higher rates of serious illness and death. Moving the performance needle to the next level requires that clinicians get as close to these patient populations as possible and establish partnerships built on trust to improve health outcomes.
Take patients who have contracted the HIV virus, for example—a population the Center for Inclusion Health, at the Allegheny Health Network (AHN) in Pittsburgh, PA, has worked with since 2000. Moving into this population as a care provider required a clear understanding of the patients being treated—patients who have little trust in the healthcare system because of both past, and in some cases present, stigmatization. To establish trust, the caregivers had to move into their world and live by their rules to be able to treat them. Team-based care is patient-driven, multidisciplinary and is designed to meet the goals patients feel are most important. Promoting health while reducing harm is the foundation of the AHN model.
That’s part of the “art” of nursing. But, to apply critical thinking to these vulnerable patient populations, nurses and other clinicians increasingly need to consider a patient’s social determinants of health (SDoH), which include a range of personal, social, economic and environmental factors that can influence a person’s health status and their subsequent outcomes. Do patients have access to transportation to get them to their appointments? Can they afford their medications? Does a patient have a support system that will help promote a healthy diet and exercise?
As today’s nurses and other healthcare professionals are increasingly tasked with caring for patients not only at the bedside, but outside the boundaries of healthcare institutions as well they need access to critical SDoH data and an understanding of how to make the best use of it. This focus must become part of greater strategies that support the continued professional development of nurses and provide advanced resources that help nurses navigate a fluid healthcare climate
Equipping Nurses with the Best Tools and Education
In a recent survey conducted by Wolters Kluwer of nearly 2,000 healthcare professionals, a full one-quarter of younger nurses believe a top priority for nursing over the next few years is to improve the health of individuals, families and communities by addressing SDoH. Another 29% agree that hospitals need to prioritize gaining access to data that helps them better respond to a patient’s social and/or lifestyle needs.
Notably, AHN’s Center for Inclusion Health recently designed and integrated the first SDoH screening tool, which is now part of the standard of care at the center. Innovation and standardization of practice like this must become a priority in healthcare organizations as they equip nurses with the tools and knowledge needed to manage complex patient populations. With the right data, necessary clinical skills and support tools that provide point-of-care access to evidence-based procedures and decision support, nurses can more effectively participate in and even drive the multidisciplinary approach to the care needed to improve outcomes for high-risk groups.
By learning to care for the most complex patients who experience disparity and stigma in our society and healthcare system we raise the standards of quality and value for everyone who walks through our doors. Nurses have to be at the front lines of this approach, hand in hand with other disciplines, because that is what they are trained and educated to do.
Healthcare is evolving, and the role of nurses is increasingly important as the clinical professionals closest to the heartbeat of patients. As the concept of care delivery becomes broader and more proactive, nurses must be equipped to address wellness, reduce disparities and elevate value in healthcare.
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