Script prompts the right questions
Conversation presents teaching opportunities
One of the main reasons the Heart Failure Program at the University Health Systems of Eastern Carolina in Greenville, NC, has been successful is that patients receive weekly telephone calls. During the conversation, Susan Ingram, BSN, program coordinator, not only reinforces education, but helps the patient learn how to take this newfound knowledge and apply it to his or her life. As a result, behavior is changed.
Following is a list of questions Ingram uses during phone follow-up and information on how she conducts the conversation. To help develop a relationship with the patients, Ingram doesn’t always ask the questions as written:
1. Have you been taking your medications as the doctor ordered? If no, explain.
Often she asks if the patient has run out of medications or had any side effects.
2. Are you keeping a daily record of your weight? If no, why not? If yes, specify weight for the last two days.
Mostly, Ingram simply asks patients what their weight is for that day. If they didn’t weigh, she uses the opportunity to reinforce education, explaining that they need to weigh daily at the same time every day and what that information reveals about their heart muscle. If they need scales, she provides them.
3. Do you know what to do with a three- to five-pound weight gain? Explain.
4. Do you understand your low-sodium diet? If no, tell me why. If yes, specify.
"Sometimes I just ask what patients had for breakfast," says Ingram. Patients usually don’t have questions until they have been discharged from the hospital and start pulling food from the cupboard to cook a meal, she says.
5. Are you keeping a record of your sodium intake? If no, do you feel you could? If yes, specify.
6. Are you keeping a daily record of your fluid intake? If no, do you feel you could? Explain.
Ingram often asks if patients are watching their fluid intake and if they are aware of how much they are drinking each day.
7. Are you able to perform your daily routine activities without becoming weak, tired, or short of breath?
At times, Ingram asks if the patient is doing any regular exercise and if he or she has had any trouble with shortness of breath or dismount exertion.
8. Have you changed your activity since you were last seen/interviewed?
9. Have you had any trouble with the following since you were last seen/interviewed: shortness of breath; dyspnea on exertion; paroxysmal nocturnal dyspnea; orthopnea?
10. Have you noticed any swelling in your ankles or abdomen? If yes, explain.
11. Have you been to the emergency department or hospital since you were last seen/interviewed? If yes, why?
During the interview, Ingram reinforces education. "Patients have a hard time making the connection that shortness of breath has something to do with their heart," she says. Also, during the telephone conversation, Ingram tries to identify any special needs patients might have that would call for the services of a social worker.
For example, a patient might not have the socioeconomic support that would enable him or her to stick to a low-sodium diet.