I was a new nurse when I met this particular patient. I heard him before I actually saw him. As his stretcher was wheeled onto the medicine floor from the ER, everyone cringed at the slurred obscenities that this diminutive man bellowed to every person he passed in the hall. He was wildly thrashing and obviously confused. He strained skinny, yellow wrists against soft restraints, and kicked wildly at bystanders.

Once admitted to the floor, the patient was appropriately medicated and supported as he began several days of alcohol withdrawal. It was a scary time for all of us, including the patient. But, within a few days, a mutual trust began to develop between this patient and the staff. And, before long, he was physically ready to go home.

While he was in our care, this patient tried, from his hospital bed, to confront thorny issues stemming from a lifetime of drinking.

Naturally, a case manager and social worker helped to address his problems while he was in the hospital. He also had many caring nurses and doctors.

Prior to his discharge, I provided him with a list of community contacts, along with a review of his condition and prescribed medications. The social worker and case manager talked with him at length about recovery options, and scheduled follow-up contact. The medical doctors gave him meticulous discharge instructions, which he eagerly reviewed. Looking back on it, I believe that this patient might have benefited from a personal health coach.

Health (or wellness) coaches are trained to motivate patients to act responsibly in order to prevent the development or exacerbation of chronic health problems. Do you think medically trained professionals are best equipped to provide this type of education?

I have seen many programs advertising health coach certification. Tuition ranges from a few hundred dollars (for a self-study course) to several thousand dollars for a series of classes.

Think about it. In our roles as nurses, we already serve as health coaches. In caring for our patients, we regularly coach them to care for themselves. Nurses routinely educate patients and family members about the patient’s condition, treatment, medication, and rehabilitation. Patient education addresses lifestyle choices and consequences of unhealthy habits such as smoking and substance abuse. We provide diet and exercise tips, along with contacts for mental health support groups.

Unfortunately, once patients leave our facility, we usually lose touch with them. Thus, we can no longer monitor their behavior; nor can we inspire or support them in healthy life choices. 

Still, while our patients are in our care, we can assist our patients as they evaluate personal lifestyle habits. We can help them to set reasonable goals. And, we can act as partners with the patient and their families in striving for optimal health. It sometimes feels as if nurses spend much of our time trying to help patients to heal, despite themselves. It can be hard to help them integrate long term recovery into their lifestyles.  But, we can help them tap into community support groups (real and virtual) by providing them with appropriate contacts. We can assure that they are assigned a case manager or social worker for follow-up.

I never saw this patient again. I like to think that he stopped drinking and found a positive lifestyle.

Do you think nurses are already serving as health coaches? How about case managers? Are non-medical people qualified to act as health coaches? Let’s hear your thoughts.