BY, RN, BSN, CCM, FCN, LNC
Health coaching for wellness to improve patient health outcomes has shown some promising results. However, it is evolving within clinical settings and is widely being used by many during the COVID-19 pandemic period. In 2020, more people used telemedicine than in previous years. Healthcare professionals were able to provide care for many by helping patients feel connected during a time of uncertainty by accessing healthcare via the internet from the comfort of their homes. Telehealth has become a mode of service delivery for people with chronic conditions.1 Case managers/coaches have adopted this practice transformation, moving from regular weekly home check-ins and collaborative meetings, to working remotely; methods include video conferencing, phone calls and texting. Patient care continued, and patients knew that they were not alone; their coaches partnered with them and ensured that they received the required care and still experienced a personal touch. Digital health coaching is an excellent option to make an impact on vulnerable patients, in building relationships with them, understanding their barriers and helping them to overcome their challenges.1
The six-week Holistic Virtual Healing Journey developed by Healthy You Lifestyle Center for patients with chronic conditions has shown strong improvement in clinical outcomes. Often people are so overwhelmed that they require care coordination and coaching to improve their health and well-being. However, physicians and insurance company care managers often lack the time, tools and training required to effectively coach patients. Patients have barriers with transportation, time, and they lack trust and relationship with their physicians and insurance care managers. The lack of trust is because the physicians and the care managers hired by insurance companies have a limited amount of time; these limited time frames prevent them from having the time they need to build therapeutic relationships. Building relationships with patients is the key for patients to successfully open up and communicate their needs.
There are many types of coaching approaches on the market. A holistic coaching approach assesses all the different systems. It uses the interpersonal connection and helps patients function in a way that promotes emotional wellness throughout their life, including mind, body and spirit. The program is designed to meet a therapeutic plan around relieving symptoms and helping patients to explore their struggles in order to develop their own insights into what they need to do to maintain their health. The coach tries to understand from the patient what is going on in their life and how it impacts their chronic condition. The approach of this program can be self-paced and directed by patients’ needs. Patients who participate in the Holistic Healing Journey program are committed to an established program with a definite start and endpoint.
The six-week holistic virtual healing journey offered by Healthy You Lifestyle center has shown the importance of calming the nervous system to promote healing, based on the polyvagal theory. In this program, the cytokine storm is regulated to calm an excessive immune response induced by external environmental stimuli.6 Cytokines have both pro- and anti-inflammatory properties. Pro-inflammatory cytokines are needed for survival, to defend against threats. Anti-inflammatory cytokines are for growth and regeneration of cells in the body. Sustained elevation of the pro-inflammatory cytokines can give rise to chronic mental and physical diseases.6 Any threat, real or perceived, can elevate inflammation in body, which is mediated through the vagus nerve.5
In six weeks, Holistic Healing Journey patients are taught simple, practical ways to reduce inflammation in the body by using the polyvagal theory developed by Dr. Stephen Porges. In polyvagal theory, Dr. Porges discusses three ways of responding to the environmental stimuli via autonomic nervous system: (1) social engagement (2) fight or flight, and (3) freeze.5
In order to reduce Inflammation in the body, and for the body to heal and rejuvenate at the cellular level, this program incorporated eight behavioral tools:
- Breathing Exercises: This technique is an efficient, integrative mind-body training for dealing with stress and emotional conditions. This is a non-pharmacological intervention for emotional enhancement, including anxiety, depression and stress.7
- Mindfulness Meditation: By practicing meditation, a person calms the nervous system and brings it back into a place of safety and regulation and out of a state of defense.5
- Expressive Writing: A form of putting thoughts and emotions on paper and discarding them immediately to disconnect from being attached to the emotions. This process helps with detaching oneself from negative thoughts and emotions.2
- Practice Forgiveness: Eliminating anger trapped inside a person. Anger elevates inflammation and is hazardous to one’s health.3 By acknowledging the built-in anger, deep wounds will be healed, so that a person can be spared from being destroyed.3
- Anti-Inflammatory Diet: Diet can assist in reducing inflammation, by increasing consumption of fruits, vegetables, whole grains, beans and legumes. Avoid inflammatory foods such as refined sugars, oils, animal products and processed foods. Eating foods that are close to their natural form will enhance weight loss, keep the heart healthy, reverse diabetes and lower blood pressure. This diet will aid in reduction of inflammation, increase energy levels and improve physical functioning. The program also introduces healthy home cooking and time management skills.
- Exercise: Physical activity is known to enhance immunity, moods, sleep and physical health. In this program various simple exercises are shown so that movement can be incorporated every hour moving away from the desk. Simple yoga pose practices are introduced to improve health and emotional well-being.
- Sleep: A good night’s sleep is essential for proper brain function and overall health. Various approaches to improve sleep are incorporated.
- Play: Including play in life can enhance relaxation and stimulate growth hormones. By bringing out the child within, anti-inflammatory markers go down and creativity flourishes.2
The program is designed for patients to review the modules each week, start implementing the tools, followed by group coaching and required homework between coaching sessions. By tapping into these tools taught in this heart-centered, solution-focused approach, the shifting and transformation occur along with the improvement in odds of surviving regardless of the circumstances. This virtual approach is a partnership with patients and tools to help overcome struggles or challenges in life. This telehealth coaching is meant to help make big shifts in life by taking small steps at a time using a very specific plan.
Incorporating remote coaching into the patients’ plan of care supports better outcomes, patient satisfaction, utilization of healthcare dollars and evidence-based lifestyle interventions.4 In turn, healthcare providers will be able to overcome barriers such as time, cost and patient non-adherence to treatment plan.