“Patient activation” refers to a patient’s knowledge, skills, ability, and willingness to manage his or her own health and care. “Patient engagement” is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly. Patient engagement is one strategy to achieve the “triple aim” of improved health outcomes, better patient care, and lower costs (James, 2013, p. 1).

Coulter (2012) reports, “Patient engagement acknowledges that patients have an important role to play in their own health care. This includes reading, understanding and acting on health information (health literacy), working together with clinicians to select appropriate treatments or management options (shared decision making), and providing feedback on health-care processes and outcomes (quality improvement).”

Strategies are focused on supporting and strengthening the individual’s determinations of their healthcare needs and self-care efforts with improved health. These strategies can attract an individual/family by focusing on their priorities and individualizing the interactions that are appropriative and comfortable (e.g., health literacy, readiness for change, accessible, affordable).

This is a very large culture change. Previously, the professional would approach health teaching with a list of what to teach and proceed to teach the contents of the list. It was concluded that the individual/family has learned. Without an understanding of the individual/family readiness or ability to learn, this “one size fits all” concludes with little understanding or motivation to change health behaviors, with a probable outcome of increased anxiety for those involved.

To engage individuals/families, health professionals focus on listening not talking, and increased question asking, to assess the specific concerns and barriers to change. The desired outcomes are increased comfort to ask questions, enhance confidence with better support, more informed, more discriminating about the effects of medical treatment, and more opportunities for participation (Coulter, 2012).

Evidence of effective engagement strategies can be (Barnsteiner, Disch, & Walton, 2014; Coulter, 2012):

Refer to Appendix D Strategies to Promote Engagement of Individual/Families for Healthier Outcomes in varied health-care settings, for example, primary/specialty care, acute care, long term.

In the last 5 years, hospitals and skilled and long-term care facilities have reorganized under the “transitional health-care model.” Previously, discharge was an event. Dramatic reengineering has changed the concept of discharge, from an event to transition as a process. Discharge was episodic and often unexpected; transition is planned and anticipated.

Transition to home or another care facility is a proactive, collaborative process among medicine, nursing, social service, physical therapy, occupational therapy, and nutritionist with each other, with community-based professionals (primary providers, specialists, home care professionals), and with the ill individual and his/her support system.

This collaborative process requires effective communication, early identification of transition date, daily review of status and early identification of barriers, clinicians responsible 7 days a week, and timely access to services in the community.

This complex process takes place in a health-care setting with extreme pressure to discharge or transfer individuals, shorter length of stays, and penalties if individuals are readmitted.

Nurses may view this new emphasis on a safe, timely transition as a means “to save finances” for the health-care institution or the third-party payer. When health-care funds dwindle, the recipients, unfortunately, suffer the most.

Buerhaus and Kurtzman (2008, p. 30) wrote:

Each day an individual stays in the hospital, the following effects occur:

On admission, all individuals will have a nursing assessment of vital signs, functional health patterns, and body systems (e.g., skin, respiratory, cardiac) using the Nursing Admission Assessment Base. Refer to Appendix B for an example.

After the initial assessment, determine the likelihood that the individual will have an uncomplicated complex transition. For the majority of individuals, the transition will be uncomplicated, as described as:

Uncomplicated transition individuals should be told prior to admission how long they can expect to be in hospital and the time of day they can expect to be discharged, so that they can plan with their support persons.