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Traditional Patient Teaching is Out.. Health Coaching is IN!

Nurses Article   (2,205 Views 21 Replies 764 Words)
by MHuffman MHuffman (New Member) New Member

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Do you know of someone who has struggled to say on a special diet, who has difficulty making exercise part of a weekly routine, or one who doesn’t quit smoking even though the risk of lung cancer related to tobacco is widely known?  OR maybe you have had difficulty changing an unhealthy behavior in your life only to fall short time after time.  Changing behavior isn’t easy, even when you know it’s better for you. Why is this? This brief article explains this interesting phenomenon and how nurses can make a difference! You are reading page 2 of Traditional Patient Teaching is Out.. Health Coaching is IN!. If you want to start from the beginning Go to First Page.

Davey Do has 35 years experience and specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

14 Followers; 1 Article; 75,863 Visitors; 6,121 Posts

 

6 minutes ago, JKL33 said:

you're not rude and mean 

BPD Patient/Client: “I'm not trying to be a pain, but..."
Traditional Psych Provider: "Oh no, what else can I do for you? I have the time!"
Psych Nurse Health Coach Response: (with supportive empathy) “You don't have to try. You're a natural!"

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9 minutes ago, Katillac said:

I see what you're saying. I think I'm overly sensitive to somebody saying essentially, "That teaching you're doing? Substandard. You need to use this new strategy that takes at least twice as long." It feels like all the other "new and exciting initiatives" that get thrown at us on a regular basis with no extra time to do them.

Of course that is reasonable, Katillac. It doesn't feel good to have one more thing in the column of "Things I will have to compromise on." I get it.

We could choose to look at it as just being a little more mindful of being therapeutic in regular patient conversations. 🙂

 

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TriciaJ has 37 years experience as a ASN, RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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4 hours ago, JKL33 said:

Being that you are seriously the best nurse ever and I can tell just by looking at your cartoons that you're not rude and mean like every single other nurse at your place, you would probably have great success with that endeavor.

And your willingness to provide 24/7 crisis intervention and the occasional place to crash would make you stellar.

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TriciaJ has 37 years experience as a ASN, RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

10 Followers; 33,504 Visitors; 3,222 Posts

4 hours ago, Katillac said:

I see what you're saying. I think I'm overly sensitive to somebody saying essentially, "That teaching you're doing? Substandard. You need to use this new strategy that takes at least twice as long." It feels like all the other "new and exciting initiatives" that get thrown at us on a regular basis with no extra time to do them. Great ideas, many of them, but just more stuff I'd love to do but never have time for. So I get defensive. My bad, something I need to work on. I get to decide what I can accomplish on a given day, and I can't do it all.  Doesn't make me a bad person, or a bad nurse. I gotta remember that!

No, I'm with you.  I'm not a fan of "articles" that boil down to pontificating to the choir.  And the material is Nursing 101.

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An internet search for the word "Coach" will state that a coach is someone who prepares, trains, or is a special or private tutor to assist someone in achieving their goals. All good things.

The program I am associated with has been doing hospital research on behavioral change since 1980 in Boston area hospitals and since that time, doing research in hospitals and centers around the country. Behavioral health change has taken on the name "health coaching" and attempts to assist with sustainable lifestyle change.

The notion that patient education is "out" and coaching is "in" is a reflection of a current and limiting mindset within health care. In 2008, my organization was invited to be a founding participant in the national effort to credential health and wellness coaches.

After 5 years of hard work and some heated discussions and disagreements, we left the consortium as the thinking of the group leaders was that "health education doesn't work and it has no part in health coaching".  While good communication skills can certainly enhance an individual's health experience and personal choices, the notion that one can sustain change without having impact on a person's core beliefs is misguided.

We behave from our beliefs. Our beliefs are "our truths" borne out of experience, environment, adaptations and interactions from a very early age, embedded in the limbic portion of our amygdala brain.

To change beliefs, the individual must embrace new information on multiple levels that leads them to believe this new understanding will provide a better survival outcome. We are driven by survival and self-protection and our beliefs are the guardrails to keep us safe.

We cannot, in fact, change old behavior without new information. It is a matter of making information available in a demystified language, without being directive or prescriptive, that connects the how and why of a situation, that allows an individual to have their "ah-ha" moment when their unconscious beliefs and their rational thoughts become integrated.

Behavior change is aligned with beliefs, values and world view and while information alone cannot and does not change them, by the same token, coaching skills without health education and information presented in a non-political, non-directive way inviting the patient into discernment, is equally as ineffective.

As a Whole Health researcher for the past 42 years, I respectfully suggest that we start with the acknowledgement that each individual has a personal process they must transverse to achieve sustainable behavior change and that using all the tools in the tool box, including whole person health education (based on 5 aspects of whole health) is an important tool to incorporate.

Reference: "Changing Behavior" by G. Donadio

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Katillac has 18 years experience as a RN.

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10 minutes ago, Dr Georgianna Donadio said:

Behavior change is aligned with beliefs, values and world view and while information alone cannot and does not change them, by the same token, coaching skills without health education and information presented in a non-political, non-directive way inviting the patient into discernment, is equally as ineffective.

I appreciate your perspective and the work you've done to arrive at it. I couldn't agree more that acquiring new knowledge without making changes in values and beliefs - and I would add priorities, because it's about choices -  is unlikely to bring a change in outcomes. In my work with in-home case management, I have used that two handed approach very effectively.

But due to limited resources, it's unreasonable to expect all nurses, at least those in acute and sub-acute care, to deliver on more than the education aspect.  Quite frankly, unlike the OP, in acute care I never saw my role as bringing about compliance. Rather, I tried to deliver information to empower the patient to optimize wellness and make change if and when they were prepared to. Just as patients aren't in hospitals or provider offices long enough to completely resolve their physical symptoms or conditions, neither are they in those settings long enough to bring about the first order change the OP is talking about.

The OP's headline assertion that patient teaching is out suggests she doesn't understand patient teaching isn't universally geared toward motivating toward lifestyle changes. It often really is about how to manage your wound vac, your PICC line, or your new baby at home. But perhaps she does understand and realizes there's no money to be made selling a course to teach health coaching if you don't convince nurses they're  delinquent in their jobs if they aren't counselors (Ooops! "skilled conversationalists") as well as teachers.

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2 Followers; 5 Articles; 1,976 Visitors; 26 Posts

I appreciate your thoughts on this and yes, as a former ER and acute care nurse, your comments about patient education for their self-care is spot on. Nurses scope of practice includes patient education as an essential component, and well it should.

The coaching movement is trying to answer the need to reduce the chronic disease statistics which is reported to cost 87% of medical dollars and that is a noble goal. For individuals passionate about prevention and wellness, health coaching is very appealing.

Health coaching, even when provided by a physician, is not a billable healthcare service. There are no codes for health coaching and no professional liability insurance to cover the services. Life coaches can get professional liability insurance but not health coaches because of the lack of continuity of training requirements, lack of oversight or regulation.

Coaching is a communication skill that everyone should have well beyond the health care system. Even the day to day work of acute care nursing can be supported with these communication skills. Your perspective is valuable and it is important that we start to have conversations about acute care nursing versus disease prevention and wellness practices as Value Care and other initiatives are emphasizing prevention and education as an important component to patient care.

Kind regards,
Georgianna

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It's understandable that some think of engaging the patient in a very different and more meaningful way through evidence-based health coaching to be "Kumbaya", "touchy feely", or simply take too long. However, others know that motivational interviewing has well over 300 studies conducted over 30 years, demonstrating evidence of its efficacy and effectiveness with adults and adolescents.  Knowing that up to 60% of patients don't follow treatment plans or take medications as prescribed, it's time we consider different ways to engage them.. And research in motivational interviewing within a health coaching context is certainly showing promise.

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58 minutes ago, MHuffman said:

It's understandable that some think of engaging the patient in a very different and more meaningful way through evidence-based health coaching to be "Kumbaya", "touchy feely", or simply take too long. However, others know that motivational interviewing has well over 300 studies conducted over 30 years, demonstrating evidence of its efficacy and effectiveness with adults and adolescents.  Knowing that up to 60% of patients don't follow treatment plans or take medications as prescribed, it's time we consider different ways to engage them.. And research in motivational interviewing within a health coaching context is certainly showing promise.

You would be wise to advocate for increased nursing time if you believe that your ideas for better communications could benefit patients.

There comes a point where your facts cannot be accommodated because of other facts. Time with patients is at an absolute premium and is currently always....always....at the expense of another patient or at the expense of the nurse's adequate job perfomance as an employee.

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Katillac has 18 years experience as a RN.

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2 hours ago, MHuffman said:

It's understandable that some think of engaging the patient in a very different and more meaningful way through evidence-based health coaching to be "Kumbaya", "touchy feely", or simply take too long. However, others know that motivational interviewing has well over 300 studies conducted over 30 years, demonstrating evidence of its efficacy and effectiveness with adults and adolescents.  Knowing that up to 60% of patients don't follow treatment plans or take medications as prescribed, it's time we consider different ways to engage them.. And research in motivational interviewing within a health coaching context is certainly showing promise.

MHuffman, please tell me, in the studies where health coaching is proven effective at delivering improved outcomes, how much time was spent teaching the doctors and nurses to perform in the role? How much time was spent in health coaching with the patients who showed improved outcomes? How was the improvement measured? How were the subjects selected? What was the percentage breakdown of classic education versus motivational interviewing in the encounters? I can't imagine you'd be telling an entire profession that they need to adopt a new interactive style with patients without giving us an understanding of what investment we need to be prepared to make in order to meet your standard of care.

Just because motivational interviewing has been effective in some circumstances doesn't invalidate or make any less important the fact that it ("simply", in your words) takes too long. Your lofty dismissal ("However, others know. . .") suggests that knockout factor is of little consequence. Instead of trying to shame nurses into taking this new burden on top of a load already unbearable at times, why not pitch it to the payer sources? If the outcomes are that much improved, why wouldn't they jump right on it and fund health coaches wherever they can be of use in reducing the bottom line?

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