Two years ago, I called a new participant in one of the chronic care programs offered by my employer a health management company that provides telephonic nursing services for people with chronic conditions. As a Registered Nurse, I help people with heart disease, diabetes, asthma, COPD, and musculoskeletal problems like osteoarthritis and headaches. On the first call, I explain that this is an educational program designed to help them be proactive about their health, so they can be as healthy as possible.
The participant, a 61-year-old real estate agent newly diagnosed with diabetes, had just been assigned to me. She was very angry, and somewhat hostile the first time I called. Its not unusual; I run into that with some employees, many of whom feel like they are being forced to participate in the programs to avoid higher premiums.
She was so upset that I decided to wait a few minutes to ask the usual assessment questions. I asked her what her concerns for herself were. She paused and then expressed anxiety about her diet. It turns out she had a lot of questions and I answered them all. By the end of the conversation, she was open to the program and has continued working with me ever since (that was two years ago).
Unfortunately, older employees with chronic conditions struggle to feel comfortable with health and wellness programs. They display an almost teenage-like rebellion against being asked to participate. The trick is to get past the skepticism and demonstrate the benefits of the programs. Heres how we try to engage employees:
- Focus on the whole person, not the illness. If they tell me that they havent been to the doctor and dont have any biometric data to share with me, I say, Thats OK, youre not a set of numbers to me. I want to know how you are today. Factual knowledge is important, but no one cares how much you know, until they know how much you care. If I work with an asthma patient who wont give up smoking, then I explore the possibility of adjusting other aspects of their lifestyle. My goal may be for them to quit smoking, but maybe they want to lose weight. The truth is that improving any aspect of a persons health has a positive impact on their overall health, and thats success.
- Help people become more knowledgeable about their illnesses. There are many people with diabetes who dont truly understand what an A1c test really is or why its important. Explaining to them that glucose attaches to their red blood cells, which could then cause life-threatening clots, really makes alarm bells go off for some people. Addressing their concerns, explaining the relationship between diet, medications and stress can lead to many ah-ha moments for people. And suddenly, theyre engaged.
- Monitor participants using devices. Nurse support in combination with at-home monitoring devices reduces unnecessary trips to the doctor (or, at least encourages appropriate trips to the doctor or ER) and saves lives. The nurse cannot be eliminated, because just giving a device to someone doesnt mean they know how to interpret or react to the information. For instance, a person with heart failure might know that losing or gaining 3 lbs in one day isnt good, but it doesnt need to translate into a call to the cardiologist.
Engaging a person who has experienced life is not easy. It takes honesty, sincerity, good critical-thinking skills, compassion and the intention to always do your best for each patient.
Julie Diane, RN, is a nurse providing telephonic health and wellness services to employees and members of Alere Healths national roster of employer and health plan clients.
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