If case managers want their discharge plans to succeed, they should take the time to really understand their patients, says Donna Zazworsky, RN, MS, CCM, FAAN, principal of Zazworsky Consulting in Tucson, AZ. Incorporate a cultural assessment into your initial assessment so you can find out as much as possible about patients’ beliefs and practices, she suggests.
If you have researched the beliefs and practices of the populations you serve, you should know something about the culture the patient comes from but you need to go further and understand each patient, Zazworsky says. The assessment should be designed to help you learn the patients’ customs and beliefs — particularly about healthcare — how closely they identify with their ethnicity and religion, their support system, the languages they speak and read, she adds.
“Case managers have to understand where each individual patient is coming from, rather than relying on generalizations,” adds Catherine M. Mullahy, RN, BSN, CCRN, CCM, president and founder of Mullahy and Associates, a case management education, training, and consulting firm in Huntington, NY.
Making assumptions about patients based on a small amount of information is dangerous, Mullahy says. “Not everybody within a given ethnic group thinks and acts the same way. Case managers need to perform a complete assessment on every patient,” she says.
During the assessment, case managers should listen to what the patient is saying — and what he or she is not saying, says Vivian Campagna, RN-BC, MSN, CCM, chief industry relations officer for the Commission for Case Manager Certification.
“The case manager should be aware of all aspects of the patient’s situation, his or her clinical, emotional, psychological, and family needs, and work with the treatment team to put together a complete package that will result in the best outcomes,” Campagna says.
Find out what is important and why, what they want out of their hospital stay, why they won’t participate in a particular treatment, and what kind of treatments they will accept, Campagna says. “Case managers should get to know the patient and family to understand the best route and the best treatment plan for each individual patient,” she says.
Ask pertinent questions to get to the “why,” she suggests. Find out why they believe what they do and why they look at treatment in a particular way. If patients and/or family members object to the treatment plan, talk to them and try to understand why they feel like they do, she suggests.
Call on a nurse or another staff member who is from the patient’s culture to help you identify who should be involved in the treatment plan and whether you should work with the patient on the discharge instructions or include a family member, Zazworsky suggests.
Find out who is the decision-maker in the family, or in some cases, in the community. It may be the patient, the spouse, or the whole family, says Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN, director of case management at Tampa General Hospital.
“Tap into the individual’s support system. It may be a spouse, an in-law, adult children, or a friend. Whoever is involved in caring for the patient and making decisions should understand what the patient should or should not be doing,” he says.
For instance, if a patient needs to limit his or her sugar intake or eat a reduced-calorie diet, the person who does the cooking in the family should be involved, he adds.