Clinical Health Coach Profile
Sandra Gianvito
| Julie: | Tell me a little bit about the role in your clinic? |
| Sandra: | I’m the Care Coordinator. We are one of about 13 outpatient clinics. I’m actually the first Care Coordinator. Dr. Carr and I started the program late 2011. I initiated the program in Brookfield and Southbury first, and now we’ve hired on 4 other Care Coordinators covering 6 offices now. It’s been fun to see the program grow. We follow the high risk CRT’s 4-6 months out of the hospital with phone calls. We call them a lot in the beginning and then every week or every other week depending on the needs of the patient. We do a lot of teaching and coaching. We get to know the patients. We follow them proactively 6 months out, but I still have patients call me 2 years later from when we started the program. They get to know you and you get to know them and it’s nice for the patient to have that one contact person. I recently used my Clinical Health Coaching skills for a community project focusing on a particular patient population. We had a project to identify some hypertensive patients who might benefit from some initial health coaching. We gave them a blood pressure cuff and showed them how to use it. We also put together a booklet and an action plan for them which included developmental goals and personal goals. We used the readiness ruler to see where they were at and how they felt about their ability to meet their goals. That was the most practical use of health coaching. I had the initial connect with the patient and then I forwarded the initial blood pressure reading and their action plan to the health district nurse. She in turn would follow up with the patient every week. |
| Julie: | Have you seen any outcomes/results? |
| Sandra: | Our last patient is finishing up in a few weeks. We will then get together to see what our numbers are. We will average the first weeks’ readings against the last weeks’ readings and hopefully the last week’s readings will be lower! As I was finishing up the Clinical Health Coach training, I was doing the hypertension project, so it was a good time for me to have it fresh in my mind. I think mostly with our older patients, with their permission, we will tell them a little bit about their heart failure and how you can help manage it at home. I hadn’t done that before. It opens the door for more questions than before. Instead of a teaching session, it’s more of an exchange of information. I have also been using it for end of life conversations. Health coaching gives ideas and better approaches to that type of conversation. I took the Clinical Health Coach online course. One little tidbit of information which I thought was pretty cool was to not be afraid to tell your patient that you are using a new approach. I used it with one of our patients who just got out of the hospital with congestive heart failure. We wanted him to watch a computer program about heart failure. So I said, “This is something new we are trying with your health. I would appreciate so much if you gave me feedback about the program”. This patient’s son was in from California and he was a teacher. He said it was so cool to see his dad so engaged in the program and writing things down so he could give me feedback. |
| Julie: | You work a lot with an older population and it sounds at times like it can be challenging. |
| Sandra: | It is a big challenge. You have to establish a rapport first. They have to trust you and know that you are going to be there to listen to them. With the 95 year old heart failure patient, I always accompany them to the doctor’s visit when they come out of the hospital for their first visit. We deal with the patients where they are. Focusing in on a particular set of behaviors is helpful. I often start my conversation focusing on what got them to the hospital in the first place and work from there. The health coaching has really helped me focus on the patient instead of trying to teach them everything I know. It’s a very different approach to nursing. I have to really think about not asking yes/no questions. |
| Julie: | What advice would you give to someone who is just beginning their journey as a Clinical Health Coach? |
| Sandra: | Really be open to it as a new way of expressing yourself to your patients. We are so used to that didactic way of teaching. As the training taught me, knowing that the patient is really the expert in what they can do and what they know how to do. That is a whole different way of thinking for nurses. So before I enter a conversation, I remind myself of that and it really helps me. Even going into the conversation with that tone is good for the patient. I feel that the patients have responded to that. This is a great practice to work in and we are used to working with the older population. We try and be patient and listen. This practice tends toward the coaching skills. |
| Julie: | Have your physicians been on board and open with Clinical Health Coaching. |
| Sandra: | : It’s kind of the mindset of our practice. It’s nice to be able to able to be in that first office visit after the patient gets home from the hospital. Our physicians have an open-ended way of conversing with our patients. After the visit, if they have any more questions for me and often they do, the open-ended approach continues. It really lets the patient see us as a team with the patient being a member of the team. They certainly are on board. It takes some of the pressure and time off of them. |
| Julie: | What has been the most valuable skill or lesson you took from the training? |
| Sandra: | The Coaching Conversation Flow Model that was presented. I have it up in my office so I can take a look at it and remind myself before I speak with a patient. |