Understanding the “Why”

by Taylor McMahon, nurse navigator and educator, Oakmont campus

I take my roles as nurse navigator and educator very seriously. I promote quality of life for our residents, and that comes in many variations, but mostly through early identification of individuals at the highest risk for readmission, those who need help with medication management and those who need education about their condition. My dual role is an essential piece to getting our residents back to their home, feeling in control and staying out of the hospital.

Patients with COPD have a higher risk of returning to the hospital. So when I had a short-term rehabilitation patient with COPD who did not understand her medications or why adhering to a medication routine was essential, I got to put my navigator and educator skills to good use.

I sat with her and we talked about her current knowledge of COPD. I’ve discovered that I am most successful when I understand what the patient understands about their condition. It is important to explore knowledge gaps so that education can be tailored to each patient.

In this patient’s case, we discovered that she was not using her inhalers the correct way, and was only using them on days she didn’t feel well.

After using the teach back method, she was able to demonstrate the correct way to use her inhalers, and understand the “why” of adhering to a medication routine.

She could tell me why she needed to take her medications exactly as the doctor ordered, and how those medications were helping her lungs. She felt empowered and was much more willing to take the steps to manage her condition. All it took was getting to know her and assessing her base of knowledge.

As part of the navigator role, I follow an extensive evidenced-based checklist to ensure that we do everything we can for a safe discharge. Making the follow-up doctor appointment, medication reconciliation, follow-up phone calls and talking to the home health provider for a smooth hand-off are just a few of the steps I take.

As I was helping my patient prepare for discharge, I was so proud when she told me that I gave her back control of her life. The role of navigator and educator has made such a difference at The Willows, our skilled nursing center. This is my “why.”