Staff combine efforts to teach osteoporosis rehab

Team members work together to reach goals

Teaching patients to live with a diagnosis of osteoporosis is a team effort at Haywood Regional Medical Center in Clyde, NC. A nurse educator, social worker, dietitian, and physical therapist all work together to help patients self-manage their disease.

"Often these patients are angry or depressed or grieving over their diagnosis. Our program turns these patients around so they don't feel that osteoporosis is controlling them, but they are controlling their disease," says Jane Lesesne, RN, BSN, CDT, Osteoporosis Center coordinator at Haywood.

Each discipline plays an important role in the education process. That process includes the following:

· Nurse educator. The nurse assesses the patient's ability to perform activities of daily living. For example, she gives them a balance test to determine if they are more susceptible to falls. "If the patient has poor balance, we'll do some high-level balance exercises with them during the four weeks," says Lesesne.

During the following sessions, the nurse educator discusses medications, fracture prevention, pain management, and relaxation methods.

· Dietitian. Patients bring a three-day food record to the first meeting so the dietitian can evaluate their diet and make recommendations. During group sessions, the patients and dietitian discuss the types of foods that prevent calcium intake, such as a high-salt diet. They also cover general good nutrition, label reading, and meal planning.

· Physical therapist. The physical therapist assesses the patient's physical fitness level including muscular strength and flexibility. Also, body mechanics are assessed to determine how each patient picks up an object and how he or she moves. Pain level is assessed, and the curvature of the patient's spine is measured to evaluate the advance of the disease at future visits.

During the following weeks, the physical therapist monitors individual exercise plans and teaches patients how to safely perform daily activities. For example, if gardening is the patient's passion, he or she will learn how to use a rack, shovel, or weed safely to prevent fractures.

· Social worker. A conversation with the patient helps the social worker learn about difficult situations in the patient's life such as lack of resources. The interview is meant to uncover anything that will prevent people from self-managing their disease.

During future group sessions, patients are taught how to cope with chronic illness. Topics covered include communication skills and identifying and dealing with depression.

Although no formal assessment of the program has been conducted, contact is kept with the patient through support groups. "Seeing these patients in our support groups, they seem to be doing well and using what they learned in the program. They seem to be coping well with their disease," says Lesesne.