A passion for improving lives: Rehabilitation and patient education at Jordan Hospital

Prevention of cardiovascular and pulmonary disease begins with education. So does recovering from surgery or an event such as a heart attack. The same is true of managing chronic conditions like diabetes or COPD, whether the goal is to help patients reduce their risks or regain their ability to function. Patients need a clear understanding of their current health status as well as what it takes to achieve a desired level of wellness. That is why the staff at the new cardiovascular center at Jordan Hospital in Plymouth, Massachusetts (see Looking after the heart, On Call, 5/15/07), which opened in January, view each point of contact, no matter how brief, as a teaching opportunity.

But the cardiovascular staff are not the only people at Jordan committed to ensuring that patients get the kind of education they need. The hospital offers comprehensive programs in such areas as cardiopulmonary rehabilitation, diabetes management, and nutritional counseling. In addition, interpreting services as well as provisions for individuals with disabilities such as hearing loss are available 24 hours a day. The professionals who develop and implement these programs are quick to point out that they benefit from their work as much as their patients do. They say they enjoy the opportunity to help patients improve their life through implementing change. They also say it is rewarding to take part in the process of updating current programs and developing new ones.

In cardiovascular services, everyone is an educator
According to Ann-Marie E. McDonough, RN, MSN, director of cardiovascular services, "Everyone is involved in patient education. This includes staff doing exercise-tolerance testing, echocardiology, vascular studies, EKGs, Holter and event monitoring, and bioimpedance studies." Joe Madison, BS, RVT, Evan Boudreau, BS, and Priscilla Vantangoli are three of those staff members who share a common perspective on the importance of providing information to patients. Madison is a registered vascular technologist doing vascular ultrasounds. Boudreau is a stress technician with a bachelor's degree in exercise and health fitness who performs preventative screening for coronary artery disease using stress EKGs. Vantangoli is a cardiac sonographer doing ultrasounds of the heart. Many of the patients these clinicians see are extremely anxious. So each of them needs to be able to help patients cope with that anxiety.

Even though the procedure Madison performs is noninvasive, he takes time to explain to each patient what is going to happen and why. He lets them know the test will be painless and will not involve injections or uncomfortable examination tables. "A lot of the patients," he says, "are anxious or in pain. I take pride in being able to relieve some of their anxiety before the test. Some even tell me afterwards they fell asleep." Madison appreciates Jordan Hospital's emphasis on ensuring that patients clearly understand what is involved in their treatment. Answering questions and addressing patient fears takes time, he says. "I have worked at hospitals in Philadelphia, Washington D.C., and New York. At Jordan, I am afforded the opportunity to spend the time needed on each patient. Many institutions, due to staffing or other constraints, can't offer this level of care."

Boudreau, who works with both inpatients and outpatients, says many of the people he sees come to the emergency room after an episode of chest pain. "One of the things I enjoy," he says, "is being able to give patients a better understanding of what they are going through." Echoing Madison, Boudreau says patients in the cardiovascular center are often nervous and require an in-depth explanation of procedures. "This is all new to them," he says. "And coming to the hospital with chest pain is frightening, so I try to put them at ease and reassure them that there is no pain involved with the procedure. Explaining what is happening is a necessary part of the job."

The ultrasounds Vantangoli performs are used to look at the walls of the heart and how they move. "We also observe how blood flows through the chambers and watch how the valves open and close," she says. "Many of the patients I see come in multiple times for the same test." Because they come back and because she makes it a point to thoroughly explain each test and each procedure, she has been able to form relationships with many of the patients.

"I find that rewarding," Vantangoli says. "When they see a familiar face, it makes them more comfortable and they feel safe sharing information about how they have been doing, and there is less anxiety about testing. I enjoy getting to know them as well." But Vantangoli's interest in educating people about what she does goes beyond working with patients. "I participate in Bring Your Child to Work Day," she says, "which occurs once a year and includes staff representation from various departments. In our area, we take pictures of the children's hearts and they really enjoy that." Vantangoli also speaks on occasion at local high schools to students who are considering careers in healthcare.

Making lasting changes through cardiopulmonary rehabilitation
Kristen Alvarenga, MS, exercise physiologist and manager of cardiopulmonary rehabilitation services, describes her department as a multidisciplinary team that includes nurses as well as representatives from social services and dietary services. The goal of the team is to help patients, even those who are reluctant, discover the benefit of making changes in their lifestyle. In the process, staff and patients often develop close relationships that both find rewarding.

Joanne Wenhold, RN, BSN, BC, and Cheryl Gomes, RN, BSN, MPH, both describe the work they do educating and assisting patients with their strengthening and conditioning programs in terms of helping them achieve their healthiest potential. Wenhold, who received her BSN from Curry College in 2006 and came to the program with a background in critical care, says she was looking for a career change and an opportunity to teach. For Gomes, the job is exciting because of the unique challenge each patient presents. "They have their own individual needs," she says. "Obesity, smoking cessation, pulmonary fibrosis." Watching patients go through the program and develop the discipline they need to achieve a new level of wellness is what she finds inspiring.

"It's all about quality of life," Wenhold says. "I educate patients about their disease and what they can do to improve their daily living." Many of the patients she sees are physically deconditioned when they begin the program, and some require assistance just to get on the machines. Working with them individually and in groups, Wenhold helps them understand the anatomy and physiology of the heart and why their medications are important. Of utmost importance, she says, is helping patients see how they can reduce or forestall complications through behavior modification and lifestyle changes that will improve their conditioning and continue after rehabilitation ends. "Helping patients make changes that last," she says, "is a primary goal of the department."

The group setting plays an important role in moving patients toward that end. Patients benefit, Wenhold says, by sharing their own experiences, by listening to the stories and suggestions of others, and by receiving support from people who have dealt with similar issues. "For example, a patient who does not have access to exercise equipment at home may find help developing a plan for walking several days a week." Additionally, the staff makes it clear that they will remain accessible to patients if problems arise.

Gomes helps pulmonary patients and those who have experienced a cardiovascular event reach their maximum potential in endurance and strength given the limitations of their current condition. One important part of the job, she says, is the work the hospital staff is doing to redevelop its prevention programs, which focus on primary prevention and changeable risk factors and are marketed to providers as well as to the community. The programs under constant review include smoking cessation, nutritional education, and the importance of exercise, with special attention given to cardiovascular health issues in women.

In addition to working directly with patients, both Wenhold and Gomes serve on Jordan Hospital's Nursing Research Council, which Gomes currently co chairs. The Nursing Research Council is made up of nurses from various departments who come together as a group to research a wide range of topics in order to support evidence-based practice. Currently, they are doing a literature search on the effectiveness of patient education in relation to readmission for patients with congestive heart failure (CHF). At the end of the project, new teaching programs will be designed for rehab patients with CHF.

Marcia Richards, MEd, RD, helps patients sort through and make sense of the abundance of nutrition information they encounter every day. "I look at challenges as opportunities," she says. "And I have the great opportunity to help people make difficult and scary changes that are effective and personal." The job of those who work in cardiopulmonary rehab, according to Richards, is to help a person prepare for change by addressing barriers, offering solutions, and providing conditions that facilitate change.

Diabetes education: a normal life that is under control
Diabetes education at Jordan Hospital is coordinated by Lois Hutton, RN, CDE. The comprehensive program uses individual counseling and classes to cover everything from information about diabetes and the use of glucometers to nutrition, weight management, and behavior modification. The main challenge, Hutton says, is knowing how to educate adult patients. "Adults have many preconceived ideas about diabetes. For instance, many believe a diabetic can never eat certain foods. I help them see they can live a normal life and maintain control over their health." Hutton says the program offers a monthly support group for patients and caregivers facilitated by nurses and dietitians.

Robin Trask, MEd, RD, CDE, counsels patients with diabetes, prediabetes and high cholesterol on carbohydrate counting, heart healthy eating, weight loss, and behavior modification. "I also teach group classes on healthy eating and weight loss," she says, "and classes on blood sugar control for our S.A.L.A.D. [Self-Management for Adults Learning About Diabetes] program." She also educates clients on glucometer use and insulin pumps. Trask points out that tight glucose control helps prevent diabetes complications and that insulin pumps are an excellent tool to mimic a healthy, functioning pancreas. "I enjoy helping people learn about diabetes and heart disease," she says, "so they are able to live healthier lives. It's rewarding to help them through a scary diagnosis and reassure them that they still have control over their disease and have the ability to change many of their risk factors."

Trask says a major objective in her job is to help people with diabetes understand that the complications they and their loved ones fear can be mitigated or eliminated through education and lifestyle changes. "It is most rewarding," she says, "when clients return with a positive attitude and, often, significant weight loss and target lipid and blood sugar levels. It's especially rewarding when they tell us the diabetes program has had such an impact that they have spread the word to their doctors, family, and friends."

At Jordan Hospital, the mission is not only to make state-of-the-art care available locally to the more than 240,000 residents of the South Shore but also to make it effective. The new cardiovascular center is evidence of that commitment. So, too, is the emphasis on education and rehabilitation, because without a staff dedicated to helping patients get the most they can out of life, no amount of technology is going to make life better or living healthy easier.

Julie Lom, RN, CDE, illustrates the dedication across the spectrum of education and rehabilitation programs at Jordan. A certified insulin-pump instructor who is working to establish protocols for the use of all insulin pumps on the market, she describes her job by saying, "I have a true passion for my role as a diabetes educator." One reason for that passion is that she genuinely understands the emotional impact the disease has. "Two of my children have had type 1 diabetes for several years," Lom says. But judging from the enthusiasm of other members of the Jordan Hospital staff, a commitment to education and effective rehabilitation is simply an inherent part of the hospital's culture.

This is the second of a two-part series on cardiovascular and rehabilitative care at Jordan Hospital. Kimberley Jordan is a nurse and a freelance writer. She also works on a telemetry unit at Jordan Hospital.