Caregivers Partnering with Patients in Chronic Disease Management

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By Megan M. Krischke, contributor

November 18, 2011 - Nearly half of all adults in the United States suffer from a chronic disease, according to the Centers for Disease Control and Prevention (CDC), which they describe as “among the most prevalent, costly, and preventable of all health problems” on their website. A 2007 report from the Milken Institute estimated that the annual cost of treating these diseases was $277 billion and the cost of lost productivity was more than $1 trillion.

It is clear that no matter which specialty they work in, nurses are regularly working with patients whose lives are affected by chronic disease.

Chronic Disease Management
Dawn M. James, MSN, RN, CNS, CDE, said nurses can have a huge impact on their communities by devoting time to preventive strategies for chronic diseases.

“Because nurses are among the most trusted health care professionals, they can play a key role in educating patients,” said Dawn M. James, MSN, RN, CNS, CDE, deputy director of public health for Kit Carson County Health and Human Services (KCCHHS) in Burlington, Colo. “The most important thing for any nurse to understand is that prevention strategies are much more powerful than trying to treat an existing disease. The more savvy and knowledgeable a nurse is about disease risk factors and prevention, the more he or she has to offer their community.”

A program that has seen success at KCCHHS is the Stanford Chronic Disease Self-Management Education Program, a peer- or nurse-led, six-week course that uses a research-based model to teach people how to self-manage their chronic conditions so that they do not get worse and can even improve their health.

“The program teaches people to do good self-management through diet, exercise, medication administration and knowing how to talk to health care providers,” explained James, who coordinates the program for a four-county area. “Each of the modules builds on how people can be better advocates for their health.”

Go Red for Women is an annual nurse-led initiative that creates collaboration between acute care providers, public health agencies and community stakeholders. The event, which is sponsored by the American Heart Association, is national in scope and held in February to coincide with Valentine’s Day. Typically a day-long event, its goal is to provide women with information on good health and how to prevent chronic diseases.

“At our event we have had nurses do demonstrations on physical activities, seminars on heart-healthy diets, and the effect of hormones in post-menopausal women, as well as discussions about cancer prevention and women’s health issues,” noted James.

Chronic Disease Management
Donna Benton, RN, encourages her hypertension patients to make one lifestyle change at a time.

In Athens, Ga., Donna Benton, RN, is the adult health coordinator for the northeast health district of the Georgia Department of Health. She coordinates the Stroke, Heart Attack and Prevention Program (SHAPP), which originated in 1974 in partnership with the CDC and provides education, detection and treatment of hypertension to people who have no insurance or who are underinsured. The goal of the program is to reduce the illness, premature death, stroke and heart disease associated with hypertension.

“One in four Georgians has high blood pressure and many don’t know it,” remarked Benton. “SHAPP particularly reaches out to people ages 30 to 59 and to the African American population because they are more likely to have hypertension at a younger age and to die earlier from its complications.”

When a patient enters the program they undergo a physical exam and a broad panel of blood work. They are given hypertension medications along with some first steps for bringing their blood pressure under control.

“We talk with them about lifestyle changes and explain this isn’t a quick-fix, fad diet. It something you do every day.  We also don’t immediately say, ‘Here is a no-salt diet,’” Benton explained. “Typically, we start by finding out what their favorite beverage is and encourage people to drink more water and fewer sugary drinks. We try to take one thing at a time and not be judgmental. They slowly start making lifestyle changes and are so pleased with themselves.”

Benton spoke with pride about one patient who lost 100 pounds and, as a result, was able to play with her grandchildren and take a part-time job.

Chronic Disease Management
Marsha Siegel, EdD, FNP-BC, urged all nurses to be on the lookout for the risk factors and warning signs of chronic disease in their patients.

Marsha Siegel, EdD, FNP-BC, immediate past president of the American College of Nurse Practitioners, urges all nurses to be aware of their role in identifying chronic diseases in patients.

“Often early intervention is paramount. In the case of dementia, for instance, there are some good drugs out there that can slow the progress of the condition. The drugs cannot, however, reverse the level of dementia, so the sooner treatment is begun, the better,” she said.

There are a variety of roles available for both RNs and advance practice nurses in chronic disease management. Nurses can head up outreach and education programs, serve as case managers or coordinate care. RNs can also work fairly autonomously as diabetes educators.

“Nurse practitioners, of course, provide primary care services and often coordinate care among the specialists a patient might need to see,” added Siegel. “There are advance practice roles for diabetic care and hypertension coordinators, as well.  In fact, NPs can run clinics specializing in hypertension care.

“When trying to motivate patients to take actions to prevent chronic diseases, it is important to work with their strengths and address what is important to them,” advised James. “I often tell people, ‘The best gift you can give your loved ones is your health. Without your health you are less able to participate in their lives and you won’t be around as long to influence them.”

“I would encourage nurses to get involved with their local and national professional associations and to look beyond their specialty so they can have a broader perspective of health over all and so they can have a stronger voice in their communities,” urged James who, among other affiliations, serves on the healthy living and prevention work group for the National Association of County and City Health Officials (NACCHO).


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