Joanne Fierro, MPH, RN, FNP-C, CNS, who works in urgent care in Los Angeles says educating is a big part of what patient advocates do, especially when it comes to chronic disease management. "In urgent care we often see patients with chronic conditions, such as asthma, that aren't well controlled," Fierro said. "Some patients have inhalers, but many don't have spacers that can be useful when patients have difficulty timing the spray with inhaling." After patients with chronic conditions are treated in urgent care, Fierro offers them educational materials, refers them back to their primary care physician, and reviews questions they can ask their doctor in order to form a comprehensive treatment plan. "I emphasize to patients that if they're taking medication and still having frequent asthma attacks, it's important to talk to their doctor about having their treatment plan adjusted," Fierro said. Fierro remembers a patient who came in to the urgent care for something minor but had blood pressure that was extraordinarily high. "This patient hadn't seen a doctor in years and although he had been diagnosed with high blood pressure years ago, he wasn't on medication," Fierro said. "Because the patient was asymptomatic, I prescribed meds to get his blood pressure down slowly, had labs drawn, and saw him for two days until he could get in to see his primary care provider. This way his blood pressure was able to be managed on an outpatient basis without an emergency room visit or a hospital stay."
Patient advocates support informed decisions
One way nurses can support patients is by helping them make better treatment choices. Educational materials, interactive tools or recommending credible sources of information can help. "The internet is an incredible tool, but we have to ensure patients use reliable patient education websites," said 13-year OR nurse Kelci Berto, BSN, BS, RN, CNOR.
"One of the best ways to advocate for patients is to meet them where they are and understand where they're coming from," said Berto, who works in the OR at UW Medicine/Valley Medical Center in Renton, Wash. "It's important to take into account each patient's story, including their medical history, culture, socioeconomic background, housing stability, and anything else that defines them."
When discussing treatment options with patients, Berto has found success asking patients open-ended questions and having them repeat back vital information. For example, if a patient is given two treatment options by their physician she asks the patient what they understand about the two options. "First, you're able to assess their knowledge, but secondly, you can help them make an informed decision as they repeat the options out loud and discuss them with their family," Berto said. "I also offer an opportunity for patients and their families to ask questions." Katlin Danielson, RN, who works as a med-surg float nurse at Fairview Southdale Hospital in Edina, Minn., paces herself when educating patients, so they take in the information. "I explain the most important concepts first, since patients can be so overwhelmed with their medical condition that they only absorb a limited amount of information," Danielson said. "I also avoid using medical jargon and acronyms, and I ask follow up/comprehension questions to evaluate how well they understand."
Building trust
Berto believes patient advocates must be attuned to patients' feelings of anxiety or worry about the uncertainty of their condition. "If my patient is in a stretcher, I meet him at eye level and gain his trust with an introduction," she said. "I offer my hand and reassurance I will take care of him while he is under anesthesia."
Berto said more often than not, she is met with a sigh of relief. "Many of my colleagues use humor as a stress reliever but it's not my forte. Instead, I ask patients if they're nervous and reassure them that what they're feeling is completely normal."
Danielson says she's found success practicing active listening when communicating with patients. "I try to be holistic in my approach, attending to their body, mind and spirit," she said. "I often find my patients' needs extend beyond medications and diagnostic procedures, to include human connection and mutual understanding."
Helping patients navigate the healthcare system
Berto said one of the most important things nurses can do for their patients is to empower them to be their own health advocates. "Navigating the healthcare system can be daunting," Berto said. "It's important to give patients the tools they need to ensure their individual healthcare needs are met."
Take these courses to learn more about communicating with patients:
Effective Communication with Patients (1 contact hr) A growing body of research has shown a variety of patient populations experience decreased patient safety, poorer health outcomes, and lower quality of care based on race, ethnicity, language, disability, and sexual orientation. Effective communication with all patients is crucial to providing safe care. The healthcare team should aspire to meet the unique communication, cultural, and familial needs of all patients. Improving Patient Education for Poor Readers (1 contact hr) Inadequate health literacy can put patients' lives at risk, and it is a major driver of healthcare costs due to preventable complications. Health literacy is not limited to the ability to read letters and numbers. It requires many skills including reading, listening, analytical and decision-making skills, and the proficiency to apply these skills to health situations. This module provides information to help nurses ensure that their patients understand vital healthcare instructions. Health Literacy and Discharge Education: I Didn't Understand (1 contact hr) When a patient or client struggles with both basic literacy and health literacy, much support is needed to help facilitate understanding of health information. Join this webinar to help increase your understanding of the state of health literacy and learn how to educate more efficiently.
