The Art of Prevention Integrating Disease_ Illness and Injury

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					           The Art of Prevention:
     Integrating Disease, Illness and Injury Prevention
                 into your Nursing Practice

                  September 10, 2003
               Nursing Spectrum Expo
               Boston, Massachusetts

Claudine Reilly, RN, MA, COHN-S, CCM, CHES, CPDM
Health Benefits Manager, FleetBoston Financial
    My Role as a Health Benefits Manager

• FleetBoston Financial is 7th largest bank in the US and
  has 42,000 employees in 1800 locations
• Benefits Planning & Design area of HR
• One of a team of 5 that manage 17 vendor relationships
    Healthcare: Medical, Pharmacy and Dental ($170M annual)
    Wellness and Fitness
    Employee Assistance
    Medical claim audits and data analysis
    Disability management (STD, LTD, FMLA, WC, and ADA)
    WorkLife
              Prevention Defined
• Webster‟s definition: “To keep from happening; make
  impossible by prior action; hinder”

• In healthcare context:
   Prevention of Disease, Illness, Injury
     • Preventive services such as immunization, preventive dental care, pre-
       natal vitamins
     • Avoidance of health & safety hazards on & off the job
     • Education
   Prevention of Death or Disability from disease, illness, injury
     • Preventive screenings such as Pap smears, mammograms, PSA
     • Avoidance of health & safety hazards on & off the job
     • Education, medical surveillance
      Optimal Health Defined
Optimal health involves the WHOLE person. It is
defined as a balance of physical, emotional, social,
    spiritual, financial and intellectual health.

                                 Communities         INTELLECTUAL
        EMOTIONAL                  Friends
        Care for Emotional                           Career Development
               Crises                                    Occupation
        Stress Management

                             OPTIMAL HEALTH                   SPIRITUAL

     Control of                                                    Love
  SubstancesAbuse                                                  Hope
      Fitness                                                     Charity
      Nutrition                                                   Purpose
  Medical Self-Care

                                Short Term Goals
                                Income Protection
                                 College Planning
                               Retirement Planning
        Optimal Health Continuum
         Change from “Diagnose & Treat to
              Empower & Prevent”

Optimal Health Is More than the Absence of Disease

              disability              signs               attitudes

  Premature                symptoms           knowledge               health behaviors   Optimal
  Death                                                   health promotion                Health

               traditional medicine

                                      neutral point
                            no discernible illness or wellness
 Optimal Health Matrix

Free of

          Low-Level     High-Level
          Wellness      Wellness
                Health Promotion Defined
“Health Promotion is the science and art of helping people change their lifestyle to
move toward a state of optimal health. Lifestyle change can be facilitated through a
combination of efforts to enhance awareness, change behavior and create
environments that support good health practices. Of the three, supportive
environments will probably have the greatest impact in producing lasting change”
O’Donnell, AJHP, 1989, 3(3):5.

 Within an organizational setting, programs can be categorized in one of three levels

 Level I                     Level II                   Level III
 Awareness                   Lifestyle Change           Supportive Environment
  Posters                        Ongoing Courses         Employee Ownership
  Booklets                       Intervention            Corporate Policies
  Newsletters                    Care Management         Physical Environment
  Email Messages                 Counseling              Corporate Structure
  Lunch Seminars                 Recreation Sports       Process & Structure
                   Fleet’s Commitment to
                       Optimal Health
                                Company-wide Health Promotion Programs

•       Intranet Web site - avg. 35,000 hits/month         •   Workout Kits (14,000 branch EE) - 1,600
•       Flu Immunization - over 9,000                      •   Smoking Cessation - 30 employees quit

•       Step by Step Pedometer Program - nearly 6,000      •   Weight Watchers at Work - 4 tons lost

•       Healthier Food Choices Program - 2,000             •   Education Packets - 900 packets

                 Customer Satisfaction Survey Results of 5,000 employees
    •       44% Response rate                                  •   93% Reported positive behavior
    •       80% Reported an increase in productivity at work
                                                               •   98% Positive feedback

                    The PATH Program (Health & Productivity Management)
                               People Achieving Total Health
        •   Health Risk Assessments (HRAs)
        •   Health Screening                                   •   Safety & Ergonomics Program
        •   Health Risk Stratification                         •   Return To Work Program
        •   1-year Lifestyle/Disease Management                •   Wellness, Fitness & Safety Kiosk
             What We Need to Do to
              Improve Outcomes

• Healthcare strategy will focus on prevention
• Understand current employee health status
    Medical claim data analysis so we can provide targeted

• 24/7 Nurse line: “Health Coach RN”
• Employ best practices approach to disease management
  and care management
• Review specialty services and market trends
      Occupational Health Nursing

• “Occupational health nursing is the specialty practice
  that provides for and delivers health and safety
  programs and services to workers, worker populations
  and community groups. The practice focuses on
  promotion and restoration of health, prevention of
  illness and injury and protection from work related and
  environmental hazards”

•      Tel: 1-800-241-8014
           A Day in the Life of an
         Occupational Health Nurse

• Variety of locations    • Variety of Activities
   Corporations             Disability case management
   Manufacturing            Health promotion
   Hospitals                Counseling and crisis
   Municipalities            intervention
   Government               Legal and regulatory
   Insurance companies
                             Worker and workplace
                              hazard detection
         Entering the Field of OHN

• Educational                         • Experience from areas
  requirements                          such as

   RN license in the state(s) of        Community health
    practice                             Ambulatory care
   BS preferred                         Critical care
   Certification recommended after      Emergency care
    4000 hours of work experience        Medical/surgical
    in a 5-year period, 50 CEUs in
    the specialty, successful
    completion of national
 Self Nurturance: The Nemcek Model

• Self-nurturance is a new force for promoting adult health
  and recognized as vital to the growth and development
  of health human beings.
• Self-nurturance “involves feelings, attitudes,
  behaviors and substances that stimulate, foster support
  life and growth.”
• Self-nurturance includes nurturing 5 aspects of the self
    Physical
    Intellectual
    Social
    Emotional
    Spiritual
           Taking Care of Yourself

                         With so much going on in
                         your life, it is absolutely
           Family        essential that while you are
                         taking care of others……...

                         you take care of YOURSELF

Patients   Self          and set an example for
                         others to follow

The Five                          5 Maintenance
Stages of
Change                 4 Action
James Prochaska, PHD

       3 Preparation

1 Precontemplation        You     Patients

            Informational Interviewing
• Informational interviewing was conceived by Richard Nelson
  Bolles, author of “What Color Is Your Parachute,” as a career
  assessment tool.

• It is a method of asking focused questions in order to gain
  valuable information

• Usefulness in helping people change behavior
    Changes the focus from external to internal direction
    Instead of reciting a bullet list of “Do‟s and Don‟ts,” asking specific
     questions enables the patient to create his/her own ideas about what,
     when and how to adopt healthier behaviors.
           How to Use Informational
• Active listening
    Observe non-verbal signals
    Paraphrase his/her statements
    Acknowledge patient‟s feelings
    Maintain eye contact and body position
    Avoid interrupting

• Effective Questioning
    Ask open ended questions
    Avoid either - or
    Respond to underlying emotional needs
    Ask questions that challenge the patient to understand and
     evaluate their situation
           Example of Informational Interviewing
         Patient: 40 yo diabetic, married father of 2, smoker, 30 lbs
          overweight, sedentary lifestyle, positive family hx of CAD

• Through active listening, you have learned that your patient would like to
  improve his health behavior but has identified the following obstacles
     Between work and family responsibilities, he has no time to exercise
     He and his wife know what foods are healthy but they do not plan and often eat on the run
     His children are “bugging him” to quit smoking

• Examples of effective questioning
    “You have said that you would like to improve all 3 areas but which one bothers you the
        most and which do you think you could tackle right now?
     “Which exercise activity do you enjoy the most and how could you fit it into your
       busy lifestyle?
     “Which „unhealthy‟ food could you cut back on and which „healthy food‟ could you add?”
     “When in the future do you think you could attempt to stop smoking?” “What can you say to
      your children now that will let them know you have listened to them and intend to quit?”
 Thank you
for your time!
            My Business Card

• Claudine Reilly,   RN, MA, COHN-S, CCM, CHES, CPDM

•   Health Benefits Manager, FleetBoston Financial
•   RI DE 033 14G
•   111 Westminster St.
•   Providence, R 02903
•   Tel. 401-278-6217 Fax 401-278-6349
•   Email:

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