By Debra Wood, RN, contributor
October 7, 2013 - Engaging patients in their own health care and helping them work in tandem with the care team has become one of the key themes in modern medical practice. The goal is to prevent illness, promote wellness and improve health outcomes, and nurses have a key role to play. They are being asked to expand their normal educational role, helping patients care for chronic conditions and make lifestyle changes--often with the aid of technology.
The nurse’s role in patient engagement
Debi Sampsel, DNP, MSN, BA, RN, said person-centered, customized care delivery systems engage the patient in decision making and accountability far greater than the previous passive learning techniques.
“Promoting patient education has always been a part of our nursing role and obligation to the patient,” said Debi Sampsel, DNP, MSN, BA, RN, chief officer of innovation and entrepreneurship at the University of Cincinnati’s College of Nursing in Ohio. “It has been a long-standing practice that nurses involve the patient across the life span in their own care.”
Sampsel finds nurses take great pride in promoting healthy lifestyles, and research has demonstrated that active, engaged individuals have far better health outcomes. The University of Cincinnati includes health promotion in the nursing curriculum and gives students an opportunity gain patient-engagement experience while working with the homeless and school age youth.
Patrick R. Coonan, EdD, RN, NEA-BC, FACHE, suggested nurses capitalize on teachable moments for patient engagement.
“What’s new is old,” added Patrick R. Coonan, EdD, RN, NEA-BC, FACHE, dean and professor at the College of Nursing and Public Health at Adelphi University in Garden City, N.Y. “I went to nursing school 35, 40 years ago and what did they teach but to be the patient advocate, to teach the patient. But we got away from that in the last few decades.”
Coonan pointed out that today’s consumers and patients are better informed. They often turn to the Internet for facts, but he called it a nursing professional’s obligation to verify whether the online information is accurate, explain how certain actions can benefit them and help them be empowered.
“As patient advocates, nurses and nurse leaders play a key role in promoting patient engagement,” said Cynthia M. Friis, MEd, BSN, RN-BC, association executive for SmithBucklin’s healthcare and scientific industry practice in Chicago. “Nurses are privileged with having the opportunity to spend more time with the patients to assess, plan, implement and then help clarify the plan of care with the patient and his/her family or caregivers. And nurse leaders are key in helping to ensure this role is realized.”
Cynthia M. Friis, MEd, BSN, RN-BC, said that nurses are privileged to spend more time with patients, and need the support of nurse leaders to ensure they can succeed at true patient engagement.
“Patient-centered care and engaging patients is very important to improving quality outcomes, which includes reducing cost and better health of populations in the community, but also reductions in disparities of care,” added Maureen Dailey, PhD, RN, CWOCN, senior policy fellow for nursing practice and policy at the American Nurses Association. She explained that nurses hold a central role in patient engagement--instilling confidence and competence in patients’ self-care, while providing knowledge, support and symptom management.
A technology boost
Along with developing the patient–nurse relationship, many nurses are finding technology can assist with their patient-engagement efforts.
“As the responsibility of nursing advances to one of building and sustaining patient activation and the role of nursing moves to be more consultative across care settings, technology will play a vital role for both the nurse and the patient,” said Karen Drenkard, PhD, RN, NEA-BC, FAAN.
Karen Drenkard, PhD, RN, NEA-BC, FAAN, said nursing has always been and will always be about the relationship and interaction with the patient.
Drenkard, who has served as executive director of the American Nurses Credentialing Center (ANCC) and past director of the ANCC Magnet Recognition Program, will join GetWellNetwork in January as chief clinical/nursing officer, where she will lead the development of a nursing model of patient engagement that includes clinical practice and technology solutions across all care settings.
Interactive technology. “Nursing can use interactive patient care technology to proactively engage the patient and shift the responsibility for completing certain care interventions,” said Drenkard, explaining patients can document daily signs and symptoms. Care providers use the network to send daily reminders about taking medications or the need for follow-up visits to their physician when data and input from the patient indicates the need to do so.
Telehealth and analytics. Telehealth also has allowed nurses to remotely educate patients, seizing opportunities to explain the objective readings transmitted through the systems’ biometric devices and how they relate to the patients’ choices--such as skipping a medication or consuming high-sodium or high-caloric foods.
“Conversations lead to learning,” said Rosemary Glavan, RN, MPA, CCM, senior vice president of clinical operations at AMC Health, a telehealth provider based in New York. “When you can show somebody that [connection], that’s powerful.”
Analytics spot trends, and nurses can intervene at the first sign of trouble. The data also helps them identify where the patient is on the readiness scale of change.
Training with simulators. At the University of Cincinnati, students not only practice patient-engagement techniques on each other, but also by interacting with a human patient simulator, and nurse practitioner acute care students learn the art of a patient engagement using a type of telehealth robot, referred to as remote telepresence.
“To be most effective in engaging patients and more so activating patients, the nursing role must evolve and develop,” Drenkard said. “The need for change and adaptation is certainly not new to our profession. However, there is a pivotal opportunity today to shift the role of the nurse away from a more task-oriented, episodic care management function to one that more centered on building, sustaining a care management relationship with a population of patients with the effective use of interactive patient care technology.”
Patient tracking systems. At the Veterans Affairs Medical Centers across the United States, military veterans are encouraged and assisted by nurses to complete and document in their My HealtheVet electronic patient-centered computerized tracking system, Sampsel said.
“This system encourages patients to be engaged with their own care by recording symptoms, information they want to discuss with their healthcare providers and other key health information that puts them in the driver’s seat of their own healthy choice living styles,” Sampsel added.
Sampsel predicted the devices in use today are the precursors to a new health care delivery that will be contained in eye glasses, wrist bands and other health data monitoring and projection technologies that will place consumer health involvement at their fingertips.
Patient portals. Patient portals, offered by electronic health record vendors, bring another element to patient engagement.
“The portals help to keep the patient’s care top-of-mind in between physician visits,” Friis said. “The portals also help bring a dimension of control into the picture. The patient can access portions of their medical record whenever they want and by doing this, it helps them to manage their care.”
Avatars and simulated office visits. “With the increase in the need for technology to help patients and their families become more engaged in health care decision making, nurses are leading the charge to create technologies that respond to the needs of patients and their families,” said Ronald L. Hickman, Jr., PhD, RN, ACNP-BC, assistant professor at the Frances Payne Bolton School of Nursing, Case Western Reserve University, and acute care nurse practitioner at University Hospitals Case Medical Center, both in Cleveland, Ohio.
Hickman has conducted federally funded clinical research focused on developing technology to promote patient engagement in health care decisions. He and his colleagues created an avatar-based simulation system that has helped people better manage their high blood pressure and symptoms of depression. He is now working on developing a software application that caregivers can use to help them become proactive in making health care decisions for loved ones who are unable to make those decisions.
Patients interact with the chronic disease management program, which simulates a physician office visit. Patients practice using SBAR (Situation-Background-Assessment-Recommendation) communication techniques as they interact with digital characters.
“It’s like a practice run of going to our doctor’s visit,” Hickman said. His research has shown that “this type of training converts to real-life outcomes.”
And many expect that nurses will increasingly be involved with helping patients engage in their care through the use of technology, which should continue to improve outcomes.
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