Create rapport to engage patients

Include family members in the assessment

When it comes to helping their patients or clients learn to take responsibility for their own healthcare, the first thing case managers have to do is to get to know them and become familiar with their family situation, says B.K. Kizziar, RN-BC, CCM, CLP, owner of B.K. & Associates, a Southlake, TX, case management consulting firm.

"I am still seeing case managers who rarely talk to or engage patients and family members," Kizziar says. "There's no way you can motivate someone to change their behavior and adopt healthy habits if you don't develop a rapport with them. The only way to determine how to approach someone about healthy habits is through dialogue, and case managers can't do that if they have their nose in the chart doing file reviews."

A case management assessment should include an assessment of the family and home environment, she says. "The only way we know what we're dealing with is to assess the patient and family. When we don't conduct an indepth assessment, we have no idea how to approach the patient and family," Kizziar says.

When someone is sick or has just been diagnosed with a chronic condition, it's a good time to get the family engaged because they're very interested in getting the family well. "Seize the opportunities that arise to educate clients and family members on healthy behavior, Kizziar say. For example, if you are working with a newly diagnosed diabetic, it's likely that if they go back to a home environment where everybody else is eating the same foods as always, they'll find it difficult to stay compliant. You have a good opportunity to talk with the family members about the importance of a healthy diet for the patient, which could carry over into a healthier diet for everyone in the family.

When you conduct your assessment, look at the family, their income level, and their understanding of health and nutrition. Are they eating fast food because it's convenient, because it's cheap, or because the person responsible for meals works long hours and never cooks?

Find out what kind of habits that family has and what culture has to do with it, then make recommendations that promote healthy behavior but are not contrary to the patient's culture, Kizziar says. "Case managers need to do research and put some thought into how culture affects a patient's health habits and determine how to speak to their needs without trying to change everything about them," she says. For instance, the Hispanic culture typically includes a diet of beans, tortillas, and other starchy foods, Kizziar points out. "You can't tell them not to eat tortillas but you can work with them on adding more vegetables and fruits into their diet," she says.

Assess your patients' healthcare literacy or level of understanding, how they view their responsibility for their health, and if they are aware that they can make an impact. Don't use technical terms. Speak in a language your clients can understand.

"You can talk to someone over and over, but if you aren't at their level of understanding, it's not going to be effective," Kizziar says.