Hospital case managers and others interested in extending case management through the use of student health coaches can implement a health coaching program with a local college.
Both hospitals and colleges can benefit from the collaboration. A program can be created with the following steps:
• Obtain referrals, and provide staff and resources. “A lot of referrals we get are from case managers, especially for the patients that have been in the emergency department and are ‘frequent fliers,’” says AlexSandra Davis, RN, BSN, MPA, director of home health services and Community Care Network at Wooster Community Hospital in Ohio.
When invited, patients can choose whether to participate. The hospital pays for staff to support the program, including Davis’ job, a clinical manager, and two licensed practical nurses (LPNs), she says. The health coaches are student volunteers, and other resources come from fundraisers.
“Even employees at the hospital have engaged in supporting the program,” Davis says. “We raised $20,000 in the community to purchase blood pressure machines and scales that we can offer free to patients.”
The program also gives patients a medication dispensing machine that costs more than $200, plus $20 per month for upkeep.
“These machines are so valuable that we haven’t had any patients (using the dispensers) admitted for medication issues,” she says. “We teach students and staff to fill the medication minder boxes with the patient’s medication, and then we set the machine to light up and send an alarm for the patient to take the meds.”
The dispensing machines open the medication holder. If the patient does not take the drug, the alarm reactivates and the patient is called by the company that monitors the machine, Davis adds.
• Recruit students. Students can be interns or volunteers. They also can earn college credit for attending the seminar on health coaching and for working with patients.
But these are not the reasons students apply to the program, notes Kirsten Peterson, MA, director of pre-professional studies and global health studies at Allegheny College in Meadville, PA.
“Students are drawn to health coaching primarily because these are students interested in working with people, often in the health field, but sometimes in social work and psychology,” Peterson says. “There are very few ways that an undergraduate can get that experience, especially for pre-med and pre-health students.”
The student health coaches learn firsthand how the healthcare system works, including about health disparities. They meet with doctors, nurses, nutritionists, and other professionals, Peterson says.
“The students assist care coordination departments of hospitals and serve as health coaches, part of our care management team,” says Tracy Meure, BSN, director of the Community Care Network at Meadville Medical Center in Pennsylvania.
Student health coaches also benefit when they apply to graduate programs in healthcare, says Steven Farrelly-Jackson, DPhil, associate professor of philosophy and global health studies, and coordinating professor of the Health Coaching Program at Allegheny College in Meadville, PA.
“When they apply to medical school, they immediately stand out because they have this background,” he says. “The medical school interviews focus a lot on the health coaching work they have done, so there are all sorts of benefits.”
• Hold seminars and didactic learning. At Wooster, the didactic portion covers these three sections:
- Introduction, including the role of the health coach and lectures about the state of healthcare and metabolic disorders, including morbid obesity;
- Diseases, including chronic illnesses such as diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension;
- Communication, including information about the teach-back method, and how to interview patients.
“We also have someone from hospice come in to talk about palliative care and hospice care,” Davis says. “We have a social worker who talks about depression, anxiety, and suicide, and we have a dietitian who talks about nutrition and disease.”
Students also practice their interviewing skills. They divide into two groups: One person portrays a patient, and others interview the patient about nutrition, social issues, transportation, and living environment, Davis says.
“Then they write a care plan in class and present the care plan to the other group, answering questions from the other group,” she explains.
• Prepare for patient encounters. A Community Care Network nurse accompanies students for the first patient visit, Peterson says.
“The purpose of the program is to not have students do things for patients, but to figure out what patients are willing to work on and to help them do that,” she says. “It could be helping patients increase their mobility, doing exercise, going for a walk — that kind of thing. The premise is that the patient is in charge.”
Student health coaches can receive clinical competency training that includes measuring blood pressure; assessing for stroke; monitoring blood sugar, balance, weight, and pulse oxygenation; and performing hand hygiene and head-to-toe assessments.
Nurses serve as clinical managers, overseeing student health coaches as they work with patients.
“The students are considered volunteers, and that’s a critical point,” Davis says. “After a referral, we go out to patients’ homes first and do an assessment to see if the patient is appropriate for the Community Care Network.”
If the patients are a good fit, they are offered a consent form that will allow health coaches to visit and work with them.
Students work with staff to develop a care plan and learn the subjective, objective, assessment, plan (SOAP) documentation method.
“That’s what they use in medical school,” Davis says. “They are taught to document and how to present their case.”
A staff member accompanies students on their first visit with patients. “We ask if they’re comfortable going back on their own or if they need us to go back with them a second time,” Davis says.
• Have health coaches visit patients and present cases. When student health coaches visit patients, they are responsible for knowing the patient’s medications, side effects, diagnoses, and the care plan.
“They have to be able to do a head-to-toe assessment and know how to do the SOAP documentation notes after the visit,” Davis says.
At team meetings on Tuesdays and Thursdays, students present their cases to the group, which consists of a co-medical director, clinical manager, LPNs, and a social worker. The professionals listen to the students’ presentations and ask questions, having them explain what the next plan of care will be, she adds.
“They also have to connect with their supervisor and present what’s going on with the patient so the supervisors know exactly what’s happening. We’re ultimately responsible for that patient,” Davis says.
• Teach students about healthcare work challenges. “Students learn very quickly about patients’ depression and the effects of family situations,” Peterson says.
Another, often unexpected aspect to working with an at-risk medical population is patient deaths.
“When students lose a patient, we take them out to lunch and we talk about how hard it is for them,” Davis explains. “We try to be compassionate with them as some of these students have never lost a grandparent or even a pet, and this is a whole new experience for them.”
The Wooster health coaching program also has brought in palliative care and hospice instructors. Patients enrolled in the program can be referred to these services, as needed.
“Sometimes, patients who seem to be doing well take a serious turn for the worst,” Peterson says. “That’s real hard on the students who have seen that.”
For example, a student health coach was working with a pregnant patient who then suffered a miscarriage.
“The student was the person [the patient] wanted with her, and that was really rough,” Peterson says. “I know that student well, and now she’s applying for medical school. The student is even more determined now to go into medicine and be that person who can help in those situations.”
On the positive side, another student health coach invited her patient to attend a sorority tea for families when the student’s own family was unable to attend.
“Her patient was thrilled to play that role,” Peterson says.