Upon completion of this chapter, the nurse will:
1. Discuss approaches when performing telephonic nursing care
2. Strategize ways to enhance patient/client learning
3. Incorporate methods to enhance patient/client acceptance and desire to maximize personal health status
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.
Telephonic teaching is a bit different than providing teaching to a client who is in the same room. Remember:
You will not be able to see the client or the environment.
You will not be able to see nonverbal responses or facial expressions.
You will not be able to watch the client read a handout.
You will not be able to see a return demonstration.
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:
Preparing to stop smoking
Advantages of smoking cessation
Ways to control your weight when quitting smoking
What to do when the urge to smoke hits
Beginning your new life as a nonsmoker
Calculating your body mass index
Planning for a realistic weight loss
Fad diets: why they don’t work
Exercise to aid in weight loss
When to measure body weight
Achieving 30 minutes a day of activity
How much exercise do you really need?
Household activities as exercise
Walking versus running
Weight training for the beginner
What do “popping” sounds really mean?
Protecting the back: improve core muscles
The importance of fresh fruits and vegetables
When dairy doesn’t agree with you
Protein sources for the vegan
How much water do I really need to drink?
What’s better: three meals a day or six smaller meals a day?
Advantages of the annual influenza vaccination
Why do I need the herpes zoster vaccination at age 60?
Does the pneumonia vaccination really prevent pneumonia?
How do I know if I have high blood pressure?
How do I know if I have diabetes?
When should I see my doctor?
When should I have a colonoscopy?
When should I have a mammogram?
When should I have a prostate exam?
Why should I examine my own breasts?
How do I examine my own breasts?
Why should I examine my own testicles?
How do I examine my own testicles?
Is it insomnia or something else?
How much sleep do I really need?
Is napping important for older people?
What does loud snoring really mean?
Alcohol versus a sleeping pill: which one is better?
Maximum daily alcohol intake for men and women
Can I have alcohol with my prescribed medications?
Specific Health Problems
What is a normal blood pressure?
How often should blood pressure be checked?
What can be done to lower blood pressure?
What causes osteoporosis?
What can be done to help osteoporosis?
What medication is used to help osteoporosis?
What causes osteoarthritis?
What is the difference between osteoarthritis and rheumatoid arthritis?
What can be done to help arthritis?
How do I know if I have arthritis?
What is total joint replacement surgery?
When should I worry about chest pain?
Why do I get chest pain after eating?
Why do I get chest pain when I exercise?
What is a heart attack?
What causes back pain?
What can be done for back pain?
Is bed rest the best treatment for back pain?
Back pain: why exercise helps
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:
What do you know about the problem?
What did your doctor tell you to do?