Nurses have long been skilled clinicians and compassionate caregivers. Now some of them are taking on the additional role of health coach to help patients who have chronic illnesses.
About 30 nurses and medical assistants at Piedmont Heart Institute and Piedmont Physicians Group just finished a five-month program to earn a certificate in health coaching and multidisciplinary care coordination.
Mercer University and Piedmont Healthcare collaborated to create this innovative certificate program through their partnership — the Center for Health and Learning, said Kevin Freeman, assistant professor of clinical mental counseling at Mercer.
“By using a team of counseling and nursing expert instructors, we were able to give people the skills to provide continuity of care across a variety of specialties, so that they can motivate and enable patients to better manage their own diseases and live healthier lives,” he said.
Mercer is offering the program to Piedmont employees through its College of Continuing and Professional Studies. Industry interest is growing and the school may expand it to a broader audience in the future, Freeman said.
In a blend of face-to-face and online instruction, participants in the 10-module program learn about the role of health coaching, as well as evidence-based practice and standards of care for chronic diseases.
“Nurses like Teri Baker provided the medical content. My role was to teach active listening and coaching strategies that would help clinicians facilitate communication and behavior change in their patients,” said Freeman, Ph.D., LPC, NCC.
By learning about various learning styles and multicultural differences, participants are better equipped to work with patients to create personalized plans, set goals and provide support.
The program was eye-opening for clinicians, said Baker, director of clinical services for Piedmont Medical Care Corp. (the parent company of Piedmont Physicians Group).
“Nurses don’t usually learn counseling skills in nursing school,” said Baker, BSN, RN. “They said that the information and skills they learned shed new light on patient behaviors and what coaches could do to foster health.”
Health coaching is the wave of the future because it fits with national health care initiatives and Piedmont Healthcare’s goals to provide better quality care and customer service at a lower cost, Baker said.
“By increasing a patient’s ability to self-manage his disease, Piedmont can reduce emergency room visits and re-admissions to the hospital,” Freeman said.
Health coaches are trained to interpret medical data to identify at-risk patients who may need more attention.
“They call patients to learn what barriers are preventing them from making appointments, having tests done or taking their medications,” Baker said.
Coaches can interpret test results and explain disease progression. They help patients make plans to achieve optimal health and find resources.
“Patients may not know about Wal-Mart’s $4 prescriptions or that their insurer offers free stress-management classes or nicotine patches,” Baker said. “Health coaching is an extension of the primary care and the patients love it. They can’t believe that someone in the doctor’s office would call them to discuss their health.”
Transition period
Figuring out how to use her new skills is taking a little time, like learning to drive a stick shift, said Daleis Hamrick, health coach for Piedmont’s Medical Home, a concept for improving primary care for patients.
“It’s a different approach, so I have to think about how I want to talk to each patient,” said Hamrick, RN, BSN, CHC. “Nurses are used to telling their patients what to do and fixing things. As coaches, we’re teaching, asking them what they want to do and helping them set their own goals and be accountable.
“It’s patient-driven and that makes sense because I may talk to patients three times a year, but they are with themselves 24/7 and have to live with the results of how they manage, or don’t manage their health.”
The course helped Hamrick think about her own ways of learning and communicating, and to recognize that others learn differently. For a diabetic who is a visual learner, a picture of a plate with appropriate portion sizes is more effective than a brochure about diet, for instance.
“From our readings and role playing, I learned a lot about motivational interviewing, which is the way we draw patients out to learn about their conditions and see how they are addressing their issues,” said Joann Gorrell, health coach with Piedmont’s Medical Home.
“I’d been a nurse for a long time, and I had heard about motivational interviewing, but I wasn’t clear on the process, so this program really helped me,” said Gorrell, BSN, RN, CHC. “All the evidence shows that the way we’ve been treating chronic illness isn’t working. The population is heavier, and there’s more diabetes than ever. We have to try something different.
“Am I sure this will work? Well, the verdict is still out. It all goes back to people taking responsibility and how well we can encourage and motivate them to do that.”
Hamrick is confident that the team will put forth the effort required to make a difference.
“Gorrell will do everything she can to discover the barriers to noncompliance with her patients and to see that they get the services they need,” she said. “Sometimes that means having the 'stick-to-itiveness’ to break through bureaucratic red tape. Health coaches are the epitome of patient advocates, and we all work together as a team.”
Both nurses believe that coaching skills have helped them improve patient outcomes.
“I’m more cognizant of how I talk with patients. I take the time to listen, and my patients like having someone they can check in with,” Hamrick said.
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