Monthly Archives: October 2012

Shared Decision Making from the Home Healthcare Perspective

Recently, I asked some folks from our company if they had any articles or insights they wished to share with the community and I got a nice reply from our branch director is Saginaw.  Peggy Fritz is one of those people who leads with her heart- you can tell from her recent work to add psychological therapy to the services offered in the her area. Below is something she shared as advice to a friend on LinkedIn.  It is about shared decision making and what Peggy has learned from her years in home healthcare.



by Peggy Fritz, RN

I have always been a patient advocate, and believe that it is important to involve the patient from the start, in all aspects of their own healthcare.  It is essential to communicate effectively with your patients and families from the beginning.  Patients who understand their problems, their treatment options, and what is expected are able to make better choices and understand why they need to make these choices.   I find it helps to share all aspects of their healthcare with them, including lab results.  Tell them the abnormal values and ask them what they could do to turn that result into a normal value.

Their care also needs to be “personalized”.  By this, I mean encouraging them to be involved.  Giving them all the information they need to be able to make their own decisions, with coaching as needed.  In my agency, all of our care plans are patient centered.  If a patient is admitted with CHF(congestive heart failure), then the interventions reflect what we need to work on with that particular patient(individualized).  These interventions are discussed with the patient and from there goals are set to meet these interventions.

This is where the patient plays a big role in their care.  The patient is asked what he/she would like to accomplish.  It does not have to be a “huge” goal, it could be as simple as being able to get to the mailbox without being short of breath. The patient is praised for any and all progress made to achieve this goal and this positive feedback helps them to keep working toward their goal.

Continuity of care also plays a role in shared decision making.   If the patient knows there is a caregiver that they can trust and build a rapport with, this will help to alleviate fear and they will be comfortable in sharing and forming a bond with them, thus becoming more involved in their own care.

Family involvement is very important.  They know the patient better than anybody else and can help with reassurance and/or anxiety.  They can also help the patient work on goals when we are not there.

It is important for patients to be involved in their own care.  It is also just as important for patients to know that you care what happens to them.  Be clear on what it is you expect from your patient, and that they understand this, and are able to follow your direction. That is, you should assess the patients understanding and capabilities, allow them to ask questions.  Once I give a patient direction for self-care, I ask them to explain the directions back to me.  If I am providing diet instruction to a patient with diabetes, I will ask them what they plan to eat at their next meal.

I tell my patients that the single most important way that they can stay healthy is to be active in their own healthcare.  It may not always be effective, but if you don’t try, how will you know?

Thank you, Peggy, for sharing your insights 🙂