Mary (not her real name) is a 70 year old woman with heart failure who lives alone, and was referred to the Hospital Admission Risk Program (HARP) for sleep issues and low mood during COVID lockdown. She woke up at 3 pm each day and was going to bed at 1 am. She had not been out of her apartment for nearly one year.
Mary was referred to Aman Kaur who is a Registered Nurse and qualified Health Coach working with our HARP at Broadmeadows Hospital and Bundoora Centre.
Says Aman, “We started working on small goals together for waking up bit earlier and doing more of the things she enjoyed, like sitting on her balcony, doing her exercises for back pain and recording her activities.”
As she started achieving these goals, she reported increased self-efficacy and used this confidence in other areas of her life, such as taking her dog out for a walk, and as COVID restrictions eased, started seeing her grandkids more often.
“This is what I see in clients that when they achieve one to two simple goals, it has a ripple effect on their lives. They use the skills and confidence gained from achieving these goals to other areas of life to achieve bigger goals, resulting in better health outcomes,” says Aman.
Health coaching is a practice in which the health practitioner applies evidence-based health behaviour change principles and techniques, to assist clients to adhere to treatment and lifestyle recommendations. Clients are supported to build confidence, focusing on strengths as they learn from past failures and successes to overcome barriers.
Says Aman, “Health coaching at HARP is a personalised, interactive and collaborative process tailored to client’s issues. Care coordinators and chronic disease management nurses at HARP refer the eligible clients for behaviour change support to minimise the risk of readmission to hospital.”
Health Coaching is provided by a Registered Nurse Health Coach, over the phone currently, but home visits will commence next year. The program runs for three to six months.
Clients with an identified health risk factor (e.g. overweight, stress, no physical activity, poor chronic disease management) and who are at risk of readmission are eligible for health coaching.
Once a client is referred, an assessment is undertaken for knowledge of self-management strategies, looking at how the client manages side effects, recognises symptoms, follows the action plan and adheres to treatment.
Based on the client’s main health concerns, two main goals are set and weekly/fortnightly calls are made to support the client’s self-management and goal attainment.
As the HARP health coach, Aman focuses on utilising motivational interviewing and low intensity cognitive behavioural therapy, that collaboratively explores strategies to break the maintenance cycle of unhelpful coping behaviours, like smoking or emotional eating, solutions for day to day challenges/barriers in maintaining behaviour change and opportunities for taking action early.
“One simple but powerful strategy is to start each call by asking questions such as, “What are your main concerns?” or “What would you like to get from today’s visit?” says Aman.
She explains, “Patient-centred care is based on mutual responsibility and expertise. Behaviour change is more likely to be maintained when goals are self-determined, as patients are both motivated to take action and are invested in the result.”
The feedback from clients has been encouraging. Clients spoke of being more positive after health coaching sessions, and more confident and determined to do things.
Anne Marie Fabri, Associate Director of Community Programs, says, “The goal of the Hospital Admission Risk Program is to reduce unnecessary and avoidable presentations to hospital. The skills and strategies that our clients can learn and identify through health coaching enables them to regain some control, focus on success and maintain better health. The collaborative approach used in health coaching exemplifies the Northern Health value ‘together’.”