“Are Nurses the Best Way to Translate New Findings to our Patients?”

“Are Nurses the Best Way to Translate New Findings to our Patients?” Nadia Thomson RN(EC) MNNurse Practitioner Ted Rogers Centre for Heart ResearchToronto General HospitalAdjunct Faculty, Lawrence S. Bloomberg, Faculty of Nursing University of Toronto Conflict of Interest Disclosures I have no conflict of interest in relation to this program or presentation. Learning Objectives •Review tips & tricks for successful communication with Heart Failure patients•Discuss the use of patient education and communication tools to improve compliance and understanding Introduction•In hospitals, clinics, communities and the home environment, nurses are integral in providing clinical care and education to HF patients and families•HF nurses provide:•Patient-centered education on HF self-care•Work within teams to adopt GDMT & new pharmacological therapies•Nurses, as part of an interdisciplinary team, are well positioned to translate new findings on the management of HF to patients•Strengthening communication between patient-provider teams is essential to improving HF patient outcomes Importance of Communication in HF CareEffective communication is essential to developing strong patient-provider relationships:•Supports patient understanding of:•HF diagnosis•Importance of medical therapy (new advances)•Engagement in HF self care•Leads to establishing treatment plans that fit with patient goals & preferences•Improves patient satisfaction with care and outcomesWe can use education tools to enhance patient-provider partnerships Communication Tips •Take the time•Actively listen•Use open-ended questions•Understand a patients’ beliefs, values & goals”What does having a diagnosis of heart failure mean to you?”1“What are some challenges you may experience living with heart failure?”2•Involve patient families and caregivers in education & discussion of therapies•Recognize that a patient’s ability to hear/learn information may be impacted by symptoms 1,2American College of Cardiology. Patient Communication Tips. https://www.acc.org Communication Tricks•Language matters -both verbal & non-verbal•Use simple plain language •Information should be direct and personalized•Build on a patient’s existing knowledge•Adopt an approach of ‘shared decision making’ •Mutual realistic goal setting -seek patient commitment •Ensure information delivered is culturally appropriate•Provide follow-up information (written materials, online tool) •Continuity -reinforce key messages at follow-up visits or through education tools Communication and Adherence•Poor communication can result in a higher risk of non-adherence•Factors affecting adherence are multifactorial:•SES•How we deliver health care:•Team based approach to education•Patient comorbidities: •Polypharmacy, depression•Therapy-related factors:•Complex medical regimen, prolonged duration of treatment•Patient factors:•Lack of knowledge about HF, fear of side effectsFerdinand et al. (2017). Improving Medication Adherence in CardiometabolicDisease. Journal of American Cardiology, 69(4): 437-451. Nursing-Led Education on Medical TherapyNursing interventions can improve medication adherence:•“What/Why/When/How/How Long” Approach•Talk honestly about benefits &risks•Discuss common side effects & management•Cost of medications (insurance coverage)•Drug interactions (OTC, herbals)•Discuss the use of personalized aids:•Charts, calendars, diary•Phone alarms•Dosette•Provide follow-up information (written, website) Beena, J. & Jose, J. 2011. Patient Medication Adherence: Measures in Daily Practice. Oman Medical Journal, 26(3): 155-159. Nursing-Led HF Education‘Patient-centered’ approach to HF education:1.Assess current understanding of HF diagnosis & treatment plan2.Explore patient perspective, preferences & goals of care3.Culturally appropriate4.Assess individual learning style5.Assess health literacy6.Deliver education that aligns with current best-practice:•On appropriate GDMT?•Opportunity for medication titration?7.Consider any physical limitations (hearing or visual impairment) in choosing an education tool Importance of Assessing Health Literacy•“The ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course.” (CPHA 2008). •Essential to assess health literacy in HF patients:•32% of patients with HF or LVAD/heart transplant have low health literacy•Patients with low health literacy were older, less formal education, English 2ndlanguage McConnery, J. et. al. (2016). Impact of Health Literacy on Knowledge and Self-Care in Heart Failure Patients, Pre-and Post-Intervention. The Journal of Heart and Lung Transplantation, 35(4):S141. Health Literacy •Low health literacy has been associated with:•↓ self-care abilities and knowledge about HF•↓ medication adherence; ↑ medication errors•↑ hospitalization and use of emergency services•↑ mortality (elderly)•↑ health care costs•Nurses can lead in assessing health literacy in HF programs and integrate into education programsEvangelista et al. (2010). Health Literacy and the Patient with Heart Failure –Implications for Patient Care and Research: A Consensus Statement of the Heart Failure Society of America. Journal of Cardiac Failure, 16(1):9-16. HF Education & Communication Tools Traditional: Face-to-FaceFact-sheets, Brochures, BooksDiaries, Action-plans Group Classes: Signs/Symptoms, Dietary modificationsIn-person support groups Web-Based:Comprehensive HF Patient Education WebsitesPatient Education Videos, Interactive online-toolsWebsite Blogs, Social mediaTelehealth Digital Tools & Apps:Remote Monitoring ProgramsWearables Evolution in HF Education & Communication Tools TRCHR: Heart Failure Patient Education Website HF Patient AppsHF apps may support key components of self-care management: •Track weights (target weight)•BP, HR monitoring•Track signs/symptoms (identify changes)•Manage medications (reminders)•Set activity goals (sync with other devices)•Nutritional goals•Connect with resources (websites); Deliver key education•Calendar for health care appointments•Record notes to discuss with health care providers Summary•HF Nurses can lead in strengthening communication between patients and the health care team •HF Nurses are critical in developing and implementing a structured approach to HF education•Innovative educational tools can be useful platforms for communicating advances in HF treatment •Choice of educational tool should be based on individual patient needs and preferences•HF teams/programs should adopt multiple education approaches•Ultimately, allmembers of the health care team play a role in educating HF patients