CHAPTER 21

Patient/Client Care

LEARNING OUTCOMES

Upon completion of this chapter, the nurse will:

TWEAKING THE NURSING PROCESS

Every nurse can recite the steps of the nursing process and most likely implements these steps without missing a beat. However, all of the steps of the nursing process are not represented in telephonic nursing care.

Assessment has been the major portion of the text so it goes without saying the importance of this step when providing telephonic care. However, clustering data and identifying appropriate nursing diagnoses are often not a part of this process. The planning of care is often standardized especially if the patient/client is in a disease management program.

That leaves implementation and evaluation. The bulk of your care will be on implementing interventions in order to help the client change behaviors. And then you will evaluate the success of the behavior change by measuring the client’s outcomes through laboratory data, improvement in symptoms, adherence to medication regimens, and not being hospitalized for a complication or new health problem. Interventions in telephonic care are provided verbally and occur through teaching.

TEACHING

Telephonic teaching is a bit different than providing teaching to a client who is in the same room. Remember:

Before beginning any teaching, you need to assess what the client already knows about a particular health problem or situation. This can be accomplished by asking “can you tell me what you know about your (disease process/medication/health problem)?” Depending on the response, you can respond accordingly.

The extent of teaching and content provided will depend on the organization, health insurance plan, or wellness program. An organization may have teaching materials or guide sheets already created to be used for specific topics. But in case standardized teaching materials do not exist, the following topics and materials would be helpful to have on hand:

Depending on the client population, additional topics and titles can be added at any time. Some organizations have contracts with patient teaching material companies who provide complete libraries of topics online for the staff to use when appropriate. An advantage of using prepared client teaching materials is not having to pay staff to research and write the materials. A major disadvantage is that the materials may not be appropriate for the client population or may lack specific disease processes or topics.

PATIENT/CLIENT REQUESTS INFORMATION

In an ideal world, all patients/clients will want to learn everything about every diagnosed health problem and will follow teaching materials to improve health or prevent future problems. Know that this will never exist, but at times you will have a client who asks for specific information for a health problem, medication, or treatment. The client who requests information is one who is prepared to learn.

When this occurs, you will not need to assess for readiness to absorb new information or ask in-depth questions. The greatest challenge might be locating the appropriate material, if the request is not routinely asked by other clients, or spending time preparing a response.

However, prior to diving in and answering the client’s question or providing teaching material, a few minor questions would be beneficial. Unfortunately, some clients may be “shopping” for information or seeking a response to a question that they “like.” For example, a client may be informed about a health problem and given a specific action or actions to take to prevent the onset of disease. The client does not want to take the recommended action and asks you what should be done about the problem. Without knowing what action was already recommended, you could fall right into a trap: “My doctor told me to do this but you are telling me to do that.” Protect yourself from these no-win situations and always ask first:

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