What’s in a name? Reframing our language to better support patients living with chronic conditions

By Margaret Dempsey, APNA Project Officer, Building Nurse Capacity Nurse Clinic Project 2021–2022 

Source: APNA Primary Times Winter 2022 (Volume 22, Issue 1)

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The way we communicate with patients and the language we use is crucial to achieving positive health outcomes. It's important that nurses take a positive approach to supporting patients with chronic conditions, rather than getting caught up in terminology that aligns with meeting Medicare Benefits Schedule (MBS) item-number descriptors. 

Increases to identified pressure points in primary health care, such as the rise in chronic disease, an aging population, pressure to manage people in the community for cost efficiency and health workforce pressures, all accumulate to impact the quality of patient care. We know that nurses are well placed to respond to and meet the demands of care, and current trends in chronic disease management are driving the need for innovative care models, including the establishment of nurse clinics.  

Primary health care nurses are pivotal to chronic disease management initiatives, but are you getting the best ‘bang for buck’ for your patients? Do you view chronic disease management with an emphasis on wellness and prevention, or is it viewed through a sickness lens? The term ‘chronic disease management’ is closely aligned with MBS item descriptors and has become embedded in the way we provide care. We rarely use this term without referring to the associated funding; however, providing care planning and health assessment services to patients encompasses so much more. 

 

Health literacy

Health literacy plays an important role for health professionals and for patients. ‘Health literacy’ refers to ‘how people understand information about health and health care, and how they apply that information to their lives, use it to make decisions and act on it.’1 The aim of health literacy is to assist patients (and their families or carers), to obtain, process and understand health information, which is necessary to make appropriate health decisions. Adequately navigating the health system is determined by individual factors that may include level of education, age, socio-economic status, or language fluency.  

The Australian Commission on Safety and Quality in Health Care describes two levels of health literacy, and these factors have an impact on the way that people access, understand, and apply health-related information and services:  

• Individual health literacy is the skills, knowledge, motivation, and capacity of a person to access, understand and apply information to make effective decisions about health and health care, and to take appropriate action.  
• Health literacy environment is the infrastructure, policies, processes, people and relationships that make up the health system.¹  

Nurses play a crucial role in supporting patients to develop their health literacy and empowering them to navigate the health system, and nurses’ language and communication styles can fundamentally impact positive health outcomes. 

According to data provided by practices participating in APNA’s Building Nurse Capacity Nurse Clinic Project, replacing terminology about chronic disease management with more positive language, such as ‘long-term conditions’, ‘living well’, ‘healthy lifestyle’ and ‘supportive care’, can give patients motivation and confidence to change their health habits, leading to better health outcomes. The following seven practices successfully applied to establish nurse clinics as part of the project and thoughtfully considered the name of their new nurse clinic service to enhance patient uptake:  

• ‘My Health, My Choice’ – Woomelang Bush Nursing Centre, VIC 

• ‘Living Well with Diabetes’ – Flynns Beach Medical Centre, NSW 

• ‘Diabetes and Healthy Lifestyle’ – Flinders University, SA 

• ‘Improve Your Heart Health’ – GPs on Curzon, QLD 

• ‘Supportive Care Clinic’ – Acacia Ridge Medical Centre, QLD 

• ‘Well Women’s and Sexual Health Nurse Clinic’ – Rockingham Medical Centre, WA 

• ‘Supportive Care Nurse Clinic’ – Thornlands General Practice, QLD 

In a rural location where access to health care can be problematic, the Woomelang Bush Nursing Centre provides an accessible service for people requiring health care and helps patients to navigate the complexities of the health system. Nurses involved in the My Health, My Choice nurse clinic help people to access appropriate medical and allied health services; the nurses arrange appointments and may often participate in telehealth consultations to ensure patients understand the choices available to them. The nurses then assist patients to access appointments, which may include arranging transport, and care of family members or pets if an overnight stay is required. 

The Living Well with Diabetes nurse clinic established at Flynn’s Beach Medical Centre uses a person-centred focus in consultations to empower patients. Lead nurse Jodie Duffy comments that ‘It’s interesting how people perceive their health. A lot of the patients attending the nurse clinic have so many different complications, but they see themselves as quite healthy. You would expect someone with a multitude of problems to come in and say, “I feel terrible” … but most of them say “You know what? I feel great.”’  The nurses maintain a non-judgemental attitude and provide positive feedback during consultations. They help patients to set their own goals, and Jodie explains that ‘by the time [patients] leave, they've got their goals in place and they've got a plan in place, and they know what to do, and they've been part of that [planning process].’  

Similarly, the Diabetes and Healthy Lifestyle nurse clinic has been established at Health2Go, which is a primary health clinic located within Flinders University, SA. This nurse-practitioner-led nurse clinic provides diabetes education and support through healthy lifestyle motivational interviewing techniques and builds on an interdisciplinary holistic model of care, referring to allied health services, including optometry, exercise physiology, physiotherapy and speech pathology. The clinic benefits staff, students and community by enhancing the knowledge of current students at Flinders University in both the undergraduate nursing courses and postgraduate allied health disciplines. 

 

Need to improve cervical screening rates

To address the need to improve cervical screening rates for women, the Rockingham Medical Centre introduced a Well Women’s and Sexual Health Nurse Clinic service. With a focus on wellness for women, patient feedback to this clinic has been extraordinary, with patients noting they are impressed with a service that offers 30-minute appointment times. ‘It's been really nice to hear the patient feedback. It's made it really easy for us to tailor the service to where people have their needs,’ said lead nurse Gabrielle Sepe. 

Identifying cardiovascular conditions as a leading cause of ill health and death in Australia² and realising that the COVID-19 pandemic changed the way in which care was delivered was the catalyst to offering Heart Health Checks to patients and optimising care for those with diagnosed coronary heart disease at the GPs on Curzon general practice. Recognising that the Heart Health Check is an under-utilised MBS item number, staff carefully considered the name used to promote this new service and the Improve your Heart Health nurse clinic was established. Structured Heart Health Checks aim to identify the risk factors of heart disease and implement early intervention strategies to reduce the risk of cardiac events. This targeted approach to care has been highly successful and the nurse clinic is consistently fully booked. 

Palliative care nurse clinics established at two general practices located in the outer Brisbane suburbs of Acacia Ridge and Thornlands aim to improve the quality of life for people living with palliative care needs. The nurses identified a level of disengagement when using the term ‘palliative care’ for patients, especially those with non-malignant life-limiting health conditions. Subsequently, a change of name to the ‘Supportive Care Nurse Clinic’ enabled conversations to progress and resulted in an associated increase in patient uptake to participate in the nurse clinic.  

The success of these clinics highlights the benefits of using positive language to engage a target patient group. Shifting the focus from having a chronic disease towards being empowered to live well with a long-term condition encourages patients to improve their health literacy and become active participants in their own health care.  

If you want to learn more about reframing your language to better support patients living with chronic conditions, APNA’s online learning module ‘Literacy: Improving Communication and Participation in Health and Health Care Delivery’ may be a good place to start. The course provides opportunities to strengthen your understanding of health literacy and how you can better support your patients. Access APNA’s Online Learning through the Education tab on our website: apna.asn.au/education/apna-online-learning. 

For more information about nurse clinics, visit APNA’s dedicated Nurse Clinic website: nurseclinics.apna.asn.au.    

 

References 

1 Australian Commission on Safety and Quality in Healthcare (ACSQHC), ‘Health literacy’, ACSQHC website, n.d., accessed 7 April 2022. https://www.safetyandquality.gov.au/our-work/patient-and-consumer-centred-care/health-literacy  

2 Australian Institute of Health and Welfare (AIHW), ‘Chronic conditions and multimorbidity’, AIHW website, 23 September 2020, accessed 7 April 2022.   
https://www.aihw.gov.au/reports/australias-health/chronic-conditions-and-multimorbidity