| Julie: | Bernice, thanks for taking time-out to talk with me today. If you could share a little bit about yourself…where you work and what your role is that would be great. |
| Bernice: | My name is Bernice Hardin, and I am an RN at Pulaski Memorial Hospital. Initially I came here as a nurse to a pediatrician here at our office. I was the immunization nurse. My doctors are only here a few times a week, so any time any of the doctors need extra help, I cover for all the physicians when needed. Whether they are on vacation, takes time off, or are sick. So, when I first started here, I was given the information about health coaching, I thought I would be a great fit. Given my RN background, I worked medical/surgical at a different hospital prior to coming to Pulaski Memorial, so it seemed a natural next step. I initially didn’t know what it all entailed, but I am always up for learning something new, always trying to continually educate myself about different things. I thought it was a great opportunity, and that is where the story started with the health coach program. |
| Julie: | How long have you been a nurse? |
| Bernice: | I’ve been a nurse for almost 10 years. |
| Julie: | So do you coach patients on a regular basis? |
| Bernice: | Myself and some others were sent to a Clinical Health Coach training program. We spent a couple of days in Indianapolis, trying to further understand how the process works by doing some type of role-playing with others taking the health coaching program. We came back, and our chief nurse officer, Linda Webb, was the one that initially got it started, based on a grant that we received. We were trying to meet some expectations as far as how many patients we could see, and enroll in this program. At first, I didn’t really realize the impact that it would have. Currently, we have over 80 patients that we have either reached out to or coach, they’ve completed their program. We have about 40 people enrolled right now. It was helpful that we were able to present to the doctors at the doctor’s meetings. This got them on board. We received referrals from our doctors here when they find patients in need of a health coach. That’s how we got it set up, we set our own system up here to monitor things, and of course we had the program through the grant to use the software for a year. |
| Julie: | How much time do you get to spend with your patients, and how often do you see them? |
| Bernice: | Initially, we try to go face to face for our first appointment. We try not to overwhelm a patient with a long meeting, so usually 30 minutes face-to-face. We sit down, get their information, and make sure their demographics are correct. From a health coach perspective, we find out what they know about their disease… what they know to be true. We get a gauge of where they are at along their journey of this disease process. Then we find out the needs that they have, if they need a glucometer or to see a diabetic dietician. Some patients need education on many things, if they need an oximeter, or even just a scale for some CHF patients. A majority of our patients are diabetics and a few CHF. We meet with them, find out what they know, and then we set goals. I try to keep it very simple. Like what are three things you think that you can work on right now? We always implement our confidence scale. I ask them, on a scale of 1-10 how confident do you feel about making these changes? What motivates you? |
| Julie: | This is a great time to find out what personality type they are, and how you can relate to them. |
| Bernice: | Exactly, you might have some that want you to call once a week to check in on them. As they get more confident and feel more empowered, they start to feel okay. We keep an eye out on their sugars. When their sugars are a little bit higher we may ask if everything is okay? Is there anything we can do to help? I think that really means a lot to people. They know we care and they realize we know what’s going on with their levels. Somedays it may have been there was a birthday party, and they had a piece of cake. They can usually identify why their sugars are high at that time. |
| Julie: | After the face-to-face, you’ll either see them again or talk to them on the phone? |
| Bernice: | Yes, we usually follow up with them. Being in an office setting it gives us the opportunity to sometimes meet face-to-face when they’re at the doctor’s office for another reason. Sometimes we just slip in and ask, “Hey how’s it going?” We usually set a time, “When is a good time to meet?” or, “When is a good time to call back?” Usually go by what the patient wants. If they say two weeks, I mark my calendar for two weeks. If they want every month that’s what we do. Always whatever the patient wants. The patients are good at calling if they have a question or a concern. But we always work together on what is best for them. We certainly don’t want to keep calling them. That’s not what they want, they’ll get annoyed. We usually work together to plan on when and how often we’ll meet up. After I call in two weeks, I ask when they like would to follow up again, do they have any questions or concerns, anything we can do, how are their goals? We basically just update everything at that time. |
| Julie: | What is the most valuable skills you gained from the Clinical Health Coach training? |
| Bernice: | I never realized that sometimes you just need to meet people where they’re at. One thing I learned from health coaching class was that if you have a doctor or nurse coming in telling you must do this and that, maybe it’s not their goals, not where they’re at in their life. Imagine if someone came in and said you must exercise 5 times a week and work out for an hour a day. The most valuable thing that I learned was that sometimes you must meet people where they’re at, talking to them, what are their goals? The smallest changes may be the biggest changes they make. I feel like when they make these small changes and they feel like that is what they’re able to do at that time, then it motivates them as they see results. They begin to think, “Wow I can do this.” “I don’t have to walk 15 minutes a day, I can walk 30!” As they’re feeling better and getting healthier, they’re able to do more. Somebody with congested heart failure… they’re backed up with fluid and they feel like garbage, you know? That is not when my goals should be used when they can’t physically meet them. I think the valuable thing I learned is just to listen to the patient, to find out where they are, and learn to meet them where they’re at. |
| Julie: | Using these skills, have you been able to see a difference in your patient’s outcomes? |
| Bernice: | Yes! For example, one of our doctors, I have heard him use a few of the strategies that we’ve used in health coaching. Asking, “what would you like to do?” Putting the responsibility back on the patient. “How confident do you feel you can make these goals?” I was impressed that he was doing the same thing during the office visits. I think it’s a great thing having people feel empowered. Usually, when we’re very sick, we depend on the doctor knowing everything. I think sometimes we rely too much on someone else to tell us what to do. I think it feels better to have the patient feel empowered, to take care of their own health, and not have someone else aid them and guide them. If we can empower them to take care of themselves, that’s huge! |
| Julie: | Can you think of a success story of a positive patient experience that you’ve had? |
| Bernice: | Absolutely… I have one that stands out above all my patients. This particular patient was very overweight, a diabetic. I got to calling and talking face-to face, I got to know her, set goals, and learn little things about her. I like learning things about people. With modern technology, we lose sight of human interaction. This woman was recently divorced, living with family, financially stretched, children with special needs. When we got to talking, her goal was to make at least two healthy meals a week. Then we talked about exercise and her love for reading. We talked about walking to the library to read and exercise with her kids. Reading helps with stress. Another goal was to go to a diabetic class. She implemented these small goals and dropped 10 pounds, A1C count went down. I also sent her cards saying, “You can do this!” My biggest take away was you don’t need to go to a gym, make all this money to make changes, you don’t have to make huge astronomical changes. It’s just small changes that you weren’t doing before that make a big impact! She now was so happy. Before, she had been abandoned by her husband and felt lonely. Now, it made her feel-good knowing there was someone who would call her every week or so to check on her. It was way more than that A1C and the weight loss. She gained confidence, a friend, and knowing someone cared about her. She has since moved away to a different state, but she definitely took away something. |
| Julie: | What would you share with colleagues, or people considering this training? |
| Bernice: | I think initially, the modules were overwhelming. I didn’t know what I was getting myself into. But, at the end of the day, it gave me insight on how to ask questions, how to wait, how to ask open-ended questions. Sometimes, you just have to modify what you know and what your patients are like. I felt like there were times with my patients when I kept using the confidence ruler and repeating myself. Sometimes you just must modify things a bit, but I think those were great, valuable skills to learn. It helps me to better communicate with my patients and I feel like I try to use that as often as I can. So, when I’m health coaching, in with patients triaging, you start to get a sense of where they’re at with things. I think people just want to be heard. I don’t think people want to be dismissed, or have their feelings dismissed. I think those coming into the training are saying, “Oh gosh, I don’t think I’ll ever use this.” But you will. It will be something that you take with you. I think that we will be able to make a much bigger impact on patients with this training. Learning not judge patients, or tell them they aren’t compliant. I think it just gives you better tools to communicate. I’m glad I went through it, it’s one of the best things I’ve done. |
| Julie: | Good, good I’m glad to hear that your doctors are on board too and that helps a lot. |
| Bernice: | Yes, it does. Doctors want to be given the black and white. They want to know what the A1C was, what is it now, etc. They just want to make sure that this program is going to work for them. We have one doctor that was not about it at first. Funny enough, we ended up getting more referrals from him than anyone else. I would go to his office and ask if there was anything he would need. I would try to build a little bit better rapport with him and show him that we weren’t trying to add any more work for him, we’re trying to help him. We’re trying to help his patients. I know the referral might seem like a pain, that he would have to go in and refer, but if he saw someone that might need that extra help, and he saw some of the positive changes in some of his patients, I think he was sold on it. We now have a lot more doctors doing referrals. We do them even from the hospital side. If we had patients being discharged with congestive heart failure, or who are diabetic, they’ll refer them to our health program. |
| Julie: | Well it sounds like you are on the right track and making great progress! We would love to have you keep us posted how things continue to go for you. I appreciate you talking with me today. Here’s to continued coaching success! |