Program stresses low-fat diet, exercise, stress relief
CMs support participants to help them meet goals
The Dr. Dean Ornish Program for Reversing Heart Disease is a dramatic lifestyle change for most people who have coronary artery disease or are at risk for the condition.
The program recommends a low-fat, plant-based diet, regular exercise, preferably 30 minutes of brisk walking a day, and stress management techniques that include stretching, meditation or prayer, and progressive relaxation.
"The nurse case manager understands the amount of support the members need to comply. We want them to know they’re not in this alone and can always call and talk to someone. Their whole role is to help the members be successful," reports Janet Banaszak, RN, CCM, national psychiatric consultant and director of case management.
After they are enrolled in the program, members undergo a physician assessment and meet with their treatment team.
The team includes an exercise physiologist, a certified stress management expert, a dietitian, a group support facilitator who is a licensed counselor, and a medical director for the program at each site.
During the first week of participation, members attend three sessions during which the various team members explain the program to them.
"They let them know why they will be doing the exercises, what stress management does and how stress affects your health, the importance of following the diet, and why this program works. This is when members get a real picture of what they are going to be doing and the importance of complying with all aspects of the program," Banaszak explains.
After the initial week, the participants meet twice a week, four hours a day for 12 weeks.
"The nurse case manager is with them for all sessions, along with the modality specialist for each area of the program," she says.
After 12 weeks, the participants are assessed to see if they need to continue with their on-site participation or if they are ready for the self-directed community. Most stay in the active part of the program for at least 12 more weeks.
The nurse case manager calls the members monthly during the first year to see how the program is working for them. "We make sure they have all the support they need. If they have questions about diet or exercise or anything, the nurse case manager puts them in touch with the appropriate specialist if she can’t answer the questions," Banaszak adds.
After the first year, participants join a self-directed community, a group of people who have completed the program and get together to support each other.
The case managers follow the members for another two years after they complete the formal program.
"The self-directed community is what makes our program unique. There is no particular structure. Each group decides how to run their community. They may have a group support session or just meet to go out for dinner," Banaszak says.
The nurse case manager follows up with members during the second and third years of the program.
"We monitor how they are doing medically, if there have been any changes in their medication, or if they have had an event," she notes.