Editor’s Note: Staci Porter, MSN, RN, is a regional nursing officer at Zynx Health. In this role, she supports the planning, development, and maintenance of clinical decision support across the care continuum. Prior to joining Zynx Health, Porter’s clinical background was in labor and delivery, postpartum, lactation, and the Level II Nursery.
Several studies have shown that if dog owners are told to walk their overweight dog more often to improve the dog’s health, the dog owners will comply, and also lose weight themselves. Their concern for their dog’s health makes the goal of increased exercise an easy one to follow. The regimen combines the pleasurable activity of spending time with a pet with a healthy activity–walking. In this way, the dogs become accidental health coaches for the human patients, encouraging them to be more active.
These studies have important implications for improving patient engagement and making care plans more effective. Care plans must activate patients’ desire for ownership and responsibility over their own health, and guide—not force—them to take a healthier path. This is best achieved when patients are offered choices and the journey is enjoyable.
Most adults don’t like to feel they’re being forced to do something. The provider’s goals for a patient may not be readily adopted by the patient. But, if both parties can collaborate on setting what the patient’s goals are and how to achieve them, the patient will develop an ownership stake in the process and will be much more likely to commit to achieving those goals
Get to know the patient
A care plan must meet the patient where he or she is, providing a relevant and meaningful starting point. A former athlete who has been derailed by knee surgery experiences different losses and has different goals than an obese patient who has never been active. A too-rigorous approach may scare off the obese patient, whereas a too-gentle approach may bore the former athlete. In either case, if a care plan is a mismatch for a patient, the patient will switch off–feeling like the program “isn’t for me.” The best approach when developing a care plan is to first discover what the patient wants and then establish the priorities.
One key is to uncover what motivates a particular patient and understand what will drive the patient to change his or her behavior and take action. Perhaps she dreams of dancing at a granddaughter’s wedding, or he wishes to run a 5K or simply take the dog for long walks. Whatever the motivation, once it’s understood, you can work together and create an individualized patient’s plan of care that is clinically appropriate and includes the patient’s goals and, therefore, is more likely to be followed.
Scale the barriers
Once providers understand their patients’ individual goals and motivators, it’s important to also grasp potential barriers, which could be intrinsic or extrinsic.
Intrinsic barriers include factors such as age, cultural background, gender, education, and income level. These are factors that cannot be changed and, therefore, must be taken into consideration when building the plan of care. Expecting an elderly patient to begin running three miles a day, or a low-income patient to join a gym may be unrealistic.
Extrinsic barriers are factors that exist outside of the individual, such as the cost of treatment, the patient’s living status, the availability of family/caregiver/community support, and insurance coverage. A patient who requires help with activities of daily living when transitioning to home from the hospital, but doesn’t have family to help, may need home health or other arrangements.
Simplify the language
Present care plans in simple terms—this is not the place for medical jargon. Also, keep in mind that different people learn in different ways. Some may prefer text or illustrated step-by-step instructions that can be posted on the refrigerator, in their bedroom, or at another handy location. Others may do better with information presented in audio or video form, or a combination of formats.
When creating a patient care plan, keep in mind the following best practices to ensure better adherence:
Involve the patients in developing their care plan.
Present the information in the way they prefer to consume it. Patients are far more likely to engage with their care plan if the information is interesting, understandable, well-presented, and focused on their needs and desires.
Show the patient different options as you develop the program together, then ensure he or she has access to it in the most appropriate format(s).
Share the plan of care with other clinicians, such as primary care physicians, specialists, home health workers, skilled nursing facility or assisted living personnel, physical therapists, and anyone else in the care continuum who works with that patient.
House the care plans in a centralized and accessible platform to improve consistency and avoid confusion, such as one provider instructing the patient to call if he or she has a five-pound weight gain and a second provider saying to call if the patient gains two pounds in two days.
Providers can learn a lot from dogs
In overweight dog experiments, the dogs were able to positively influence their owners’ healthy behaviors. Applying some “dog lessons” to care plan development may be valuable. For instance, dogs are loyal. They encourage their owners by wagging at the door or greeting them with their leash in their mouths. But they also meet their owners where their owners are–even if it’s on the couch while watching Netflix.
Dogs don’t chide or criticize, but they do advocate—insistently– for fresh air and exercise. They provide companionship and support, with encouragement and without judgment. In order to optimize clinical outcomes, providers should commit to delivering similar care plans that are empathetic, customized to each patient’s unique situation, and fully considerate of the patient’s goals and motivations.