My nursing education journey began when I received my BSN in Nursing at Rutgers College of Nursing in 2011. During my time there, I met some strong, professional women professors. They took such a personal interest in me that, over a decade later, I think of them with much gratitude. Their strength helped me to see myself as a strong but caring nurse.
A Strong Caring Nurse
My education gave me the confidence to care for my patients competently. I had a tough clinical practice specialist on the Med/Surg/Tele unit I first worked on. When she asked me questions on the spot, I almost always knew the answer. I credit Rutgers and fellow student nurses who supported each other through nursing school.
Prisca Benson, MSN, RN is a a nurse navigator for the neuroscience department at The Valley Hospital
While there was a lot to learn on the job, the education I received provided a foundation I used to excel clinically. It was not long before I started picking up per diem job opportunities to explore and broaden my horizons as a nurse. I worked in home care as an intake nurse, home care nurse, and infusion nurse for different companies.
In 2014, I got a job as a neurology nurse at my dream hospital, NYP-Columbia University Hospital. While per diem there, I joined committees I was interested in and disseminated the information to the staff in my unit to improve our practice.
I also noticed that some patients lacked a basic understanding of their medical history and medication. So I used the principles I learned in school to educate them effectively so they could be more knowledgeable about their health and care.
A Life’s Passion Realized
I soon realized that my passion was teaching.
I began searching for nursing opportunities to give me more time to teach patients. I applied for a position as Neuroscience Nurse Navigator at The Valley Hospital, which allowed me to create and develop the role to support the patients during their admission and help them maintain outpatient follow-up.
This was a dream come true! I finally had the time to sit at a patient’s bedside, teach them about their new diagnosis and answer all their questions.
While working this job, I received my MSN in Nurse Education at Chamberlain University. The modalities taught have allowed me to be a better peer and patient educator. It encouraged me to start with the other person’s understanding as a foundation for effectively educating someone. I participated in my organization’s student nurse externship by teaching skills, theory, and even creating an educational game to increase knowledge retention.
Love and Desire to Educate
My love and desire to educate led me to start a personal finance and health blog, Our Green Life, during the pandemic. The fear and misinformation were very unsettling, so I wanted to provide a reliable but approachable space for information. I use what I have learned through my education and experience to make the information easy to grasp and to demonstrate how it could be applied.
My nursing education helped shape my career, goals, and values, and I will be forever grateful for it.
September is National Cholesterol Month, making it a great time for nurses to revisit tools for educating patients about maintaining healthy cholesterol levels.
Nurses learn in nursing school about the two types of cholesterol: low-density lipoprotein cholesterols, or “LDLs”, and high-density lipoprotein cholesterol, or “HDLs”. Some cheeky nursing professors might teach their students that LDL’s are lousy, while HDL’s are happy, or the good and the bad cholesterol, respectively.
The goal for many patients is to elevate their HDL and lower their LDL levels, and nurses can play a big part in helping them achieve this. Maintaining healthy cholesterol levels is essential to well-being, and the consequences of not doing so can cause a great detriment to one’s quality of life and even death. The most notable sequelae of high cholesterol are a heart attack and stroke.
The Value of Patient Education
Many nurses take pride in their more technical skills such as phlebotomy, insertion, management of venous catheters, medication administration, and the development of nursing diagnoses and care plans. In many ways, however, patient education is a nurse’s most important task because it can prevent the need to carry out those more technical tasks that treat disease. Patient education instead is wellness-promoting. When it comes to cholesterol, it is a nurse’s greatest asset in assisting patients to avoid the potentially devastating consequences of unhealthy cholesterol levels.
Individualized Lifestyle Patient Education
Perhaps the most obvious factor to focus on regarding cholesterol is diet. For every fad diet, new superfood, and fasting regimen, there is a simple solution suitable for each individual patient. In order to effectively educate a patient about diet, the nurse must be armed with a straightforward understanding of where the patient is both physically and emotionally.
This means the nurse must know the patient’s existing dietary restrictions and needs based on physical conditions, such as carbohydrate restriction related to diabetes mellitus and salt restriction for heart disease. Emotionally, the nurse must also have an understanding of the patient’s dietary preferences and level of willingness.
A patient who claims to hate vegetables is unlikely to comply to eating a healthy cholesterol diet that is predicated on heavy vegetable consumption. This patient might do better if directed toward other dietary sources that support healthy cholesterol levels like oatmeal, berries, and other foods high in soluble fiber. Similarly, if a nurse works with a patient who makes clear that they are unwilling to stop eating fast food, the nurse might suggest a bowl of soup, a large glass of water, or a generous slice of watermelon helps hydrate before a meal. Hydration offers a wealth of health benefits besides relieving thirst, which many dehydrated patients confuse for hunger.
Stress management is not only a tool for a more pleasant daily life, but it is also an essential component of healthy cholesterol levels and overall wellbeing. Chronic stress can throw off our bodies’ cortisol release cycle, and there is a clearly defined relationship between abnormally elevated cortisol and high cholesterol.
Again, individualized patient education is key. Relaxation, sleep, and exercise are three fundamental components of managing cortisol and its effect on cholesterol. This doesn’t mean that every patient will be willing to start meditating, following a strict bedtime, and running marathons. By meeting with the patient and learning about their hobbies, the nurse may discover the patient loves to knit, dance, and read. For this patient, the nurse may recommend knitting to relax, dancing to music for fifteen minutes a day, and going to bed with a good book rather than watching the news.
The Role of the Nurse
Patient education is the nurse’s greatest asset in helping patients to establish lifestyle measures that support healthy cholesterol levels. In order to do this effectively, nurses must establish a rapport with a patient that engenders trust and understanding. This allows both the nurse and the patient to create a plan for the patient that is both effective and feasible to promote a patient’s cholesterol levels. Use September as a time to remind patients they are worth it!
When it comes to having surgery, many people will think mostly about the operation itself more than the postoperative recovery period. As a nursing professional, you will know that this is actually only half the battle! The surgery itself can be the easier part, as it is done in a very controlled environment and within a set timescale.
Postoperative recovery on the other hand is not so simple. There can be a whole range of issues that crop up for your patients, which can cause them discomfort or even result in the surgery being a failure. With this in mind, it is vital to find ways to care for your patients in a way that makes any post-op period a success.
This is an area within nursing that has seen many changes over the years in how it is approached. This has affected not just the patients themselves, but also you as the nursing staff who look after them.
What exactly has changed in postoperative care?
Rehab has become more essential – for your patients, the essential role that rehab plays in recovery from surgery has grown over the years. The importance of not only accessing the right kind of rehab but also taking advantage of it is very important to your patients. This has been made easier over the years, as more hospitals make rehab exercises and sessions open for your patients to engage with. This will not only get them moving around but also give them specific exercises to help recover faster.
Diet is key – healthy eating has seen a much-improved profile in recent years and this has also been seen in postoperative recovery. For patients, it is key that they remember to eat the right foods and follow a diet rich in the right minerals to help their body heal. Of course, this has also affected hospitals, where healthy food is now expected to be served to patients.
Education – when it comes to changes in how nursing care is done post-op, patient education is a key factor. Now, more than ever, you would talk to the patient after the op to inform them of what they can do to help speed up their recovery. This not only allows you to provide a better level of care for them, but also helps make the surgery an overall success.
Increased postoperative pain awareness – when it comes to being a nurse, one of the big challenges that you will face is helping the patient to deal with any post-surgery pain. There have been many advances in this area, from closer monitoring of post-op patients’ pain levels to finding alternative ways of helping patients to manage pain.
Advice around too much sun for patients – while you will be aware that some vitamin D and fresh air is good for recovery, it has been found that too much sun is not great for post-op wounds. An excess of UV rays can actually harm the tissue around surgical scars, and damage the area. With this in mind, it is much better to enjoy any trips outside for patients in moderation and to consider advising the use of sunscreen to help protect the relevant areas of the skin.
One area within postoperative pain relief for the nursing and medical profession that is seeing change is the move away from opioid-based pain relief. As noted above, patients are now far more likely to be advised by medical staff to rely more on alternative therapies or less addictive painkillers to help them recover in the long term. Advances made by Dr. Erol Onel in this area have seen effective pharmaceutical options to help patients experience less risk when managing post-op pain.
Naturally, the way that you care for your patients and the way they themselves interact with the recovery process has seen considerable change. As time goes on, innovations such as the development of non-opioid pain relief could bring even more change, which will lead to you being able to provide a much better level of care to any patients in your charge.
The health care industry is one of the most prominent sectors of the country. According to CDC reports, 600,000 people in the United States die every year due to heart disease. As documented, the health care cost in the United States was $3 trillion in 2014. This sums up to about 20% of the GDP. As the demographics evolve and chronic illnesses become rampant, these figures are expected to reach over $4.3 trillion. This is why the emphasis on health care and preventive medicine is gaining popularity.
When people take better care of themselves, they are less likely to fall ill and hence place a little burden on the health care system. This is one reason local governments sponsor health awareness campaigns.
The Evolving Role of Nurses
Amidst the need to improve health care delivery and sustain a better living for the people, the role of nurses has become multi-dimensional. Not only are they performing their typical duties in hospitals, caring for their patients and managing essential tasks, they are also playing a role in promoting health care awareness among different segments of the society.
According to a 2015 study published in International Journal of Community Based Nursing and Midwifery, nurses could identify cardiovascular health issues, supervise improvements, and bring about greater patient satisfaction through their diligence when contrasted against primary health care providers. This included identifying smoking habits, documenting weight changes, and recording blood pressure to pinpoint pain areas.
Through the reputation nurses have gained while working in close collaboration with medical practitioners, their word has already gained much value in the eyes of the people. So when a nurse recommends a specific procedure and/or gives a medical advice, people are more likely to follow through with it. As individuals belonging to the health care industry, nurses have been playing an important role in raising awareness about various preventable diseases.
Nurses and Remote Medical Assistance
Given the limited number of licensed medical practitioners and their human limitations, nurses are quickly taking on the role of providing health care solutions at a distance. In fact, their role in crisis management is unparalleled.
Telehealth is successfully run by nurses, diverting patients to the right health care centers to save time and reduce damage. While the distance implies physical examination cannot be conducted, they can ensure the patients receive medical attention at the right time.
Nurses Promoting General Health Care
Every interaction between the nurse and the patient is an opportunity for information exchange whether in person or via a HIPAA compliant telemedicine app. While the doctors focus on diagnosing diseases and treating them, nurses can educate the patients about related issues and teach them how to take better care of themselves. This not only takes some burden off the medical practitioners but also makes sure the patients are well-informed and well-included in their health-related decisions.
The current era in health care is all about patient inclusion, particularly in framing and recommending health care solutions. Nurses, in their unique capacity, can promote patient compliance via informal communication to make them feel heard and understood. This yields better results, quicker healing, and higher patient satisfaction. As hospitals and clinics turn towards a profit-oriented business-like model of operation, patient satisfaction becomes imperative for the institution’s success.
Despite a nurse’s best efforts, some patients aren’t willing to follow instructions, but the impacts of patient noncompliance are too serious to ignore.
Prescription drugs provide an excellent example of the importance of adherence. It’s estimated that up to 30% of prescriptions go unfilled and as much as 50% of medications for chronic disease are not taken as directed according to a study published in Annals of Internal Medicine. The study’s authors go on to say that failure to follow prescriptions causes about 125,000 deaths per year and up to 10% of hospitalizations.
Nurses can enhance patient understanding of and adherence to their overall treatment plans by strengthening communication, rapport, and education.
It Starts with Communication
Asking the right questions and opening the lines of communication between patient and nurse can uncover critical barriers to treatment compliance.
Pose questions in a constructive, problem-solving manner. For example, “I see that you have not been completing your daily exercises. I wonder if they are causing you too much pain, or if there is some other reason?”
Try to relate personally to the patient to build a stronger therapeutic partnership. Get the patient to express what the nurse and care team can be doing to help them better meet their personal health goals.
Set and adhere to a discussion agenda for every encounter. Begin with a discussion of the patient’s personal goals and issues before moving on, such as “First, tell me what concerns you most, and then we’ll discuss test results.”
Encouraging Cooperation and Participation
Explain to patients that they must take some responsibility for the outcome of their care and treatment. Let them know that everyone caring for them wants them to be successful in regaining their health. If barriers to compliance persist, try asking the patient what he or she believes would be more effective. The goal should be to achieve a mutually acceptable care plan.
Clearly and explicitly convey the severity of the problem and the risks of not properly carrying out instructions. Give the patient an opportunity to ask questions and clarify the instructions.
Find out if there are any underlying factors affecting compliance. For example, “It sounds as though you may be concerned about the medication’s possible side effects. Is that why you have not taken it as prescribed?”
Identify any practical or logistical difficulties that may hinder compliance.
End each encounter by having the patient verbalize at least one self-management goal.
Enhancing Patient Education and Understanding
Key barriers to communication – such as low health literacy, cognitive impairment, or limited English – need to be assessed early on to help uncover the best solution for successful communication.
Have access to qualified and credentialed interpreters for use when necessary.
Ask patients if they have any questions about their medications and ask that they describe in their own words how to take them.
Consider involving a health coach, health navigator, and/or case manager for the patient.
Ask patients to repeat critical instructions and paraphrase in everyday words the medical information they have been given.
Helping Patients Manage Logistics
Sometimes a patient’s noncompliance issue is out of their hands due to a lack of personal support at home or financial restraints. Uncover where those patients are struggling:
Do health care information records note who can help your patient when they’re outside of the health care setting? Do they have the consistent help of a spouse, relative, friend, or paid caregiver to aid with their care?
Are patients asked whether they can get to appointments via car or public transportation, and are responses documented in the patient care record?
If a patient lacks the physical or mental capacity to perform such essential tasks as changing dressings or picking up prescriptions, has a relative or friend been asked to assist, with the permission of the patient or legal guardian?
Does the patient lack the financial resources to comply with their current care plan? Are they concerned about the out of pocket costs for treatment, or having to take time off of work?
Document these concerns in the patient care record, and work with the patient and their primary care provider (with the patient’s permission) to find solutions.
Supporting the Effort with Documentation
To help staff deal with hostile, manipulative, or uncooperative patients, written protocols should be in place to help all staff respond to and deal with difficult patients. This should include ways to document and procedures for such common concerns as:
Repeated prescription refill requests of questionable nature
Narcotic use and general pain management in drug-seeking patients
Appointment or procedure cancellations
Unacceptable behavior, such as belligerent voicemail messages or yelling or cursing at staff
After-hours patient calls
Refusal to consent to recommended treatment
Neglecting to take medications, do exercises, or make necessary lifestyle changes
Terminating the patient-provider relationship
Monitoring Compliance
Driving patient compliance often means health care teams need to repeat themselves again, and again, and again. Different tools and strategies can help nurses drive compliance.
Remind patients of upcoming appointments, including referrals and laboratory visits, via telephone and/or email.
Try electronic alerts to remind patients with a history of noncompliance about screening and monitoring requirements.
Inform blind or visually impaired patients of subscription services that use wireless devices to deliver reminders to take medications or perform vital self-care activities.
Schedule follow up and referral appointments before patients leave the facility.
Document no-shows and conduct telephone follow-up within 24 hours.
Know if there is a written policy for terminating the patient-provider relationship if the patient is chronically noncompliant and fails to respond to reminders and other messages.
Keep at It
Patient noncompliance is a deep issue with no easy answers or simple solutions. Nurses in almost any setting will encounter noncompliant patients, but with consistent communication and a persistent, but cooperative, spirit nurses can work to overcome the risk of noncompliance one patient at a time. Nurses also can explore Nurses Service Organization’s patient self-assessment checklist to help facilitate open communications.
Disclaimer: This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice. It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter.
