Digital Repository Masters Projects Spring 2025 Impact of Nurse-Led Follow-Up Education Phone Calls Kylee Kendell Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Kendell, K. 2025. Impact of Nurse-Led Follow-Up Education Phone Calls. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Impact of Nurse-Led Follow-Up Education Phone Calls Project Title by Kylee Kendell Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY 04/25/25 Ogden, UT Date Kylee Kendell RN, BSN, MSN student 04/25/25 Student Name, Credentials (electronic signature) Date JoAnn Tolman, DNP-L, MSN-Ed, RN, CNE 04/25/2025 MSN Project Faculty Date (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. 04/25/2025 Date 1 Impact of Nurse-Led Follow-Up Educational Phone Calls Kylee Kendell, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purpose: Patients with chronic liver disease require health literacy to adhere to comprehensive treatment plans. The aim of this project is to increase nurse confidence and improve workflow by providing a follow-up educational phone call to patients with chronic liver disease. Rationale: A summary of the literature shows that chronically ill patients who do not receive educational follow-up are more likely to experience noncompliance, increased readmissions, and decreased prognosis. Nurses coordinating care may experience increased workload and decreased confidence. Methods: Lewin’s theory of change was utilized to develop the project. Nurse coordinators attended an educational presentation and received a guided checklist to provide a nurse-led educational phone call, address treatment plans, and discuss medications with 24 hours after a new patient visit. A pre- and post-intervention survey gauged nursing confidence regarding resources, education delivery, and impact on workflow. Results: All Registered Nurse coordinators implemented the use of the guided checklist. Implementing a structured follow-up educational phone call to chronically ill patients by utilizing a guided checklist improved the nurse coordinator’s confidence and workflow, and enhanced job satisfaction. Conclusions: Nurse-led telephone follow-up in the form of an educational phone call reduces nursing workload by enhancing patient health literacy, improving communication, and increasing treatment compliance. Improved nursing workflow leads to increased job satisfaction and increased nursing confidence. Keywords: Nurse-led, educational phone call follow-up, confidence Impact of Nurse-Led Follow-Up Educational Phone Calls 3 Managing patients living with chronic liver disease can be challenging for a variety of reasons. One concerning area is the need for more adherence by the patient to individualized treatment plans to support health (Panahi et al., 2022). Patients living with chronic disease benefit from treatment plans and collaborative care from a variety of healthcare providers, such as a primary care physician, a nurse coordinator, or a collaboration of physicians and specialty clinics, such as digestive care, family medicine, home care, and rehabilitation, (Mayo Clinic, n.d.). Healthcare providers at specific transplant and hepatology clinics collaborate with patients to create a realistic treatment plan during a clinic visit to promote health and evaluate disease status by reviewing laboratory findings and imaging results and discussing goals with the patient during routine clinic visits (Sharma & Nagalli, 2023). Nurses act as treatment plan coordinators to ensure patients meet the care goals for the best outcome. However, patients are at risk for disease progression, increased outpatient clinic visits, hospitalizations, hospital readmissions, treatment failure, and life-threatening outcomes (Naghavi et al., 2019) if there is a lack of adherence and follow-through with treatment plans. Statement of Problem Lack of adherence to individualized treatment plans in patients treated with chronic liver diseases, such as cirrhosis and liver failure, can result in a myriad of complications, including hospitalization and death (Cleveland Clinic, 2023). Lack of adherence results from low motivation, poor health literacy, forgetfulness, and insufficient patient-provider communication (Baryakova et al., 2023). The Registered Nurse (RN) coordinator establishes a relationship with the patient to provide care management support and ensure the patient's understanding of their treatment plan 4 by answering questions, assisting with scheduling, relaying test results and information, scheduling future clinic visits, and coordinating care specified in the patient's treatment plan. When patients fail to follow through with their treatment plans, this has a poor impact on both the RN coordinator and the patient. The RN coordinator's workflow increases due to the excess time and resources employed to ensure the patient understands possible risks and efforts required for the completion of needed lab work, imaging studies, and routine clinic visits for the patient. The increased workload increases stress and decreases nursing confidence in care management, affecting the overall quality of care delivered (Li-Yin et al., 2019) and exposing the patient to subpar or poor-quality care. There is a need for timely follow-up education for the patient early in the care process to promote understanding and adherence to the treatment plan, requiring more confidence and expertise in the RN coordinator's ability to prevent and treat health risk behaviors (Brathwaite et al., 2018). Implementing a secondary touchpoint to educate further, provide clinical support, and stress the importance of adherence to the medical treatment plan can positively impact patient satisfaction and knowledge and reduce hospital readmissions (Schievelbein, 2020). This MSN project aims to implement a structured follow-up educational phone call from the RN coordinator to the patient to emphasize critical areas such as confirming patient understanding, verifying and clarifying information, giving recommendations, and motivating patients to engage in their care (Gustafsson & Wahlberg, 2023). Implementing educational programs increases provider confidence, effectiveness, and belief in programs to change patient health behaviors (Brathwaite et al., 2018). Significance of the Project 5 Poor health literacy negatively impacts a patient's ability to self-manage their disease and an individual's health behaviors, such as adherence, screening recommendations, and cessation of poor behavior (Coughlin et al., 2020). Nurse-led education can improve adherence and outcomes in patients living with chronic disease (Arad et al., 2021). Implementing timely followup education through a telephone call to the patient will allow the nurse to address knowledge deficits and deliver the necessary information to improve patient adherence (LucianiMcGillivray et al., 2020). The telephone follow-up call also provides another opportunity to meet patients' communication and information needs (Woods et al., 2019), closing the education gap in the care process. Disruption of a nurse's workflow organization and processes can determine work pressure and stress on the nurses delivering care, interfere with work performance, and affect the quality of patient care (Ferramosca et al., 2023). Direct support from management to improve work environments and patient safety can help enhance clinician well-being (Aiken et al., 2023) and reduce negative implications directed toward patients. Furthermore, implementing effective interventions to reduce workload and improve workflow and job satisfaction reduces job turnover (Niskala et al., 2020). Implementing a follow-up educational nurse-led telephone call to patients with chronic disease will improve nurse confidence, workflow, and patient outcomes. Review of the Literature A literature review evaluated current evidence on using structured, nurse-led follow-up education for patients with chronic disease. The literature reviewed was used to determine the impact on RN coordinator confidence and workflow improvement in managing patients with these chronic diseases by utilizing a structured phone call or checklist during follow-up. Framework 6 Adaptation to change is vital in healthcare today due to the constant demand for change in healthcare to meet the changing needs of a population, meet demands to increase life expectancy, and manage complex health conditions (Figueroa et al., 2019). Implementing best practices utilizing change management theories, such as Lewin's Theory of Change, has improved the likelihood of success and better practice outcomes (Barrow & Annamaraju, 2022). Lewin's theory functions under three main phases: the unfreezing, moving, and refreezing stages. The unfreezing phase occurs after identifying the need for change, the moving phase involves initiating the new process, and the refreezing phase includes establishing the new status quo (Barrow & Annamaraju, 2022). Furthermore, Lewin's theory proposes that change is influenced by restraining forces or obstacles that counter the driving forces or positive forces for change to occur, resulting in the equilibrium of the status quo (Nursing Theory, n.d.). Change management models, such as Lewin's Theory of Change, provide a frame of reference for those seeking change and provide insight into elements required for a change to occur and sustain (Harrison et al., 2021). The stages of Lewin's Theory of Change provide structure and organization during the implementation of the educational follow-up phone call. According to Walk (2022), during the unfreezing stage, leaders inspire change by exposure to ideas and perspectives regarding what could be, fostering a sense of hope and optimism among RN coordinators. Additionally, this is a valuable time to educate the RN coordinators on the purpose and value of the proposed changes. The unfreezing stage is necessary for leaders to educate RN coordinators about the need for change to decrease workload and improve nurse confidence. During the moving phase, nurse leaders provide feedback and support throughout implementing an educational nurse-led follow-up phone call and the importance of continued 7 use. Furthermore, during the refreezing phase, nurse leaders' support is crucial to strengthen the use of the new process by providing constructive comments, motivating staff, incentivizing, if necessary, and providing appreciation to prevent regression (Pahl & Rowsell, 2020) as well as using this time to share outcomes with key stakeholders. Strengths and Limitations Utilizing Lewin's theory for change has associated strengths and weaknesses. For example, Lewin's model is simple to use and understand, focuses on behaviors, and utilizes behavioral psychology to understand why people resist change, with findings based on psychological data to combat resistance to change (OCM Solutions, n.d.). This model's limitations include scarcity or needing to be more detailed to contribute to individual interpretations. The model could also be outdated, too rigid, and combative rather than nurturing (OCM Solutions, n.d.). Analysis of Literature This literature review aims to identify variables contributing to patient noncompliance and how nurse-led education improves patient compliance, nurse confidence, and job satisfaction. Literature analysis was conducted for themes related to the PICOT question: For RN coordinators who manage patients with chronic liver disease, will a nurse-led follow-up educational phone call using a checklist, compared to no phone call or checklist, improve confidence and improve workflow with managing treatment plans for patients with chronic conditions? Search Strategies The literature search identified current evidence utilizing Google Scholar, EBSCO, and Pubmed. Articles are evaluated if written between 2019 and 2024 to keep information current. 8 The search included keywords such as nurse-led, follow-up, outcomes, patient satisfaction, workload, and education, and several Boolean combinations used to create a broad search. Further criteria included in the literature were patients who lived with chronic illness, had recently had an overnight stay in the ER or hospital, or had a recent clinic visit. Synthesis of the Literature Three themes developed through the literature evaluation: 1) There is a relationship between workload and quality of care, 2) nursing-led programs are effective, and 3) electronic education communication is efficient. Relationship Between Workload and Quality of Care The quality of patient care is impacted when the nursing workload increases (Dhaini et al., 2020), and disruption of this flow and organizational process can affect the quality of care received (Ferramosca et al., 2023). Missed nursing care is identified as when the right action is delayed, partially completed, or incomplete, resulting in poor patient outcomes and enhanced job dissatisfaction and absence among nurses (Phillips et al., 2021). Factors such as work environment, teamwork, and staffing have shown to be the most consistent predictors of this phenomenon, contributing to burnout and job dissatisfaction (Phillips et al., 2021). Further, literature shows that factors such as increased workload and high stress can negatively impact care and may force nurses to omit care, do it briefly, or delay (Dhaini et al., 2020), contributing to poor quality care. Nursing confidence is at risk. For example, Cho et al. (2020) indicate that when nurses cannot provide comprehensive care by their professional standards, it affects the quality of nursing care. Additionally, Johnson et al. (2020) describe that high stress is also associated with 9 low self-esteem, and healthcare workers with lower self-esteem or high stress were significantly associated with burnout. Effects of Nurse-Led Programs Individuals benefit from nurse-led education (Bhattad & Pacifico, 2022). One study by Jiang et al. (2024) shows a significant improvement in anxiety, depression, and self-care activities in those individuals who received nurse-led follow-up educational programs and additionally had improved knowledge regarding their disease and its threat to their health compared to those patients who did not receive nursing-led follow-up. Arad et al. (2021) identified that nurse-led follow-up showed a significant difference in treatment adherence and improved laboratory scores in individuals who received it compared to those who did not, contributing to the belief that nurse-led follow-up leads to increased compliance and patient knowledge. Further, care can be delivered virtually without inhibiting the quality of care (Handiyana et al., 2024). For example, one randomized control trial conducted by Henriksson et al. (2021) found that after 36 months, patients with chronic conditions who received a nurse-led, telephone-based follow-up that included medical information had significant improvement in vital signs and labs and were successful in reaching target values compared to those who did not. From the nursing perspective, personal feelings and confidence are essential. A recent cross-sectional study found a significant increase in job satisfaction when nurse's self-esteem and confidence were enhanced (Ghaleh et al., 2024). Furthermore, Ghaleh et al. (2024) reiterate that managers and healthcare organizations need to recognize the influence of self-esteem on job satisfaction to ensure that nurses are supported and empowered to foster that well-being and lead to improved patient care and health outcomes. Further evidence supports that providing follow- 10 up care gives nurses positive feelings and experiences and a sense of pride in building closer patient relationships (Handiyana et al., 2024). The use of education materials specific to patient diseases or diagnoses has the potential to enhance patient compliance. Bhattad and Pacifico (2022) state that healthcare providers' personalized education materials and verbal education improve physical and psychosocial wellbeing, patient satisfaction, and shared decision-making. Berardinelli and Bernhofer (2020) explored that when RNs provide excellent instructions to their patients, it may also increase patient health confidence. Education delivered in person and by an RN should be considered a standard, further supporting the need for nurse-led follow-up implementation. Use of Electronic Follow-Up Education Functional health literacy extends beyond the basics of reading and writing. It includes the ability to interpret images and oral communication. Using communication that incorporates simple design, plain language, and graphic displays improves health literacy (Coughlin et al., 2020). Implementation of electronic communication is an option for timely education (Timmers et al., 2020). As Brathwaite et al. (2018) clarified, implementing educational programs can further positively affect patient behaviors. The use of electronic follow-up had the potential to improve not only nursing workflow but also nurse satisfaction. Following the implementation of formal training, 51% of healthcare professionals expressed that they felt that electronic methods for patient education would make patient education easier, faster, and more efficient, whereas 33% felt they were very likely, and 13% felt somewhat likely (Bhattad & Pacifico, 2022). Providing care electronically also can improve timely delivery. Timmers et al. (2020) identified that educating patients with information through a digital platform improves timely delivery and increases patient levels of knowledge, medication or treatment adherence, patient 11 satisfaction, and clinical outcomes while improving healthcare economics. Kuwabara et al. (2019) further explain the benefits of health technologies by improving care delivery without traditional constraints, such as location concerns, distance, and time delays. Furthermore, using digital health technology improves patient education and the implementation of behaviors (Kuwabara et al., 2019) Summary of Literature Review Findings and Application to the Project In summary, there is a strong correlation between nursing workload and the quality of care received. Implementing strategies to reduce workload can enhance patient perceptions and outcomes. Furthermore, nurse-led follow-up education can enhance compliance and reduce the overall workload for RN coordinators. Utilizing electronic communication for education provides an enhanced opportunity to deliver timely feedback, enhance knowledge, and improve health literacy. Findings from the literature support an enhanced education process to improve RN coordinators' workflow and patient compliance. Therefore, a nurse-led follow-up educational program via telephone will improve nurse confidence and support good patient outcomes. This process would be most beneficial to patients receiving treatment in the liver transplant clinic who experience a delay in either notification, response, or change to their treatment plan, which results from the increased effort and resources utilized by the RN coordinator towards encouraging those who are non-compliant and struggling with adherence. This excess effort and resource expenditure contributes to the increased day-to-day workload in the RN coordinator's workflow and increased response time to deliver care. Project Plan and Implementation 12 Yasmin et al. (2020) discussed the significant improvement in patient adherence and overall medical regimen plan due to the implementation of mobile health and, therefore, should be considered a supplemental option for those living with chronic disease. This project will target Registered Nurse Coordinators providing care in the Liver and Kidney Transplant setting and involve implementing a nurse-led follow-up process through an educational telephone call within 48 hours of all new patient visits. This process will utilize a structured checklist tool to aid RN Coordinators in the timely delivery of treatment plan education and assist in managing patient care. Plan and Implementation Process A literature review revealed evidence for a project that provides follow-up patient education. Follow-up education can improve patient care, improve treatment adherence and health literacy for patients, and decrease workload stress for nurses. This evidence is presented to key stakeholders such as registered nurse coordinators, nurse managers, nephrology and hepatology teams, and the surgeons in the Liver and Kidney Transplant clinic to gain approval for a process change, and to implement the project and deliverables. The deliverables for this project include a) a pre-survey for nurse coordinators, b) an educational presentation for nurses, c) a structured, guided checklist tool for follow-up education, and d) a post-survey for nurses. The stakeholder presentation emphasizes workflow improvement, communication amongst staff and patients, health literacy, and treatment plan adherence. Once project approval is obtained, implementation begins. The project will begin with the introduction of the pre-intervention survey of the RN coordinators to assess the nurse’s confidence and job satisfaction with delivering educational phone calls. Evidence collected from the literature review will also guide the creation of 13 educational materials, such as the checklist tool for the Registered Nurse Coordinators, regarding strategies to improve follow-up education, communication, and care management of chronically ill patients. A structured checklist will be generated utilizing evidence-based data and best practices to enhance patient outcomes. A pre-intervention survey will be delivered to the registered nurse coordinators during in-service. It will assess the nurses' current job satisfaction, confidence levels, delivery of educational phone calls, and patient care management. Following the pre-survey, Registered Nurse Coordinators will attend a mandatory educational in-service meeting held in person, using a PowerPoint presentation on current data supporting the need for follow-up education and telephone follow-up process, as well as receive the guided checklist. Time will be provided to allow for staff to ask questions or gain assistance. At the time of these in-service, goals and expectations will be discussed, and the timeline will be delivered to follow up in 1 month to assess nursing confidence and job satisfaction after using the guided checklist tool. One month after implementation, nurses will attend a post-intervention meeting, at which time a post-intervention survey will also be delivered. The purpose of this survey is to learn if the follow-up phone call and checklist improved the Registered Nurse Coordinators' current confidence level and workflow. Following the completion of the survey, time will be provided for discussion to evaluate opportunities for improvement, current barriers, and staff participation for further improvement. Leadership staff emphasize expectations regarding the follow-up call process and staff involvement. Interdisciplinary Team 14 At the start of this project, a committee consisting of the Nurse Manager, Nurse Educator, lead Medical Assistant, and Hepatology supervisor is created to begin the education process. Project Lead. The project lead is a registered nurse and MSN student. Project lead will be responsible for delegation of roles and responsibilities, supervision of research collection and act as liaison between key stakeholders, patients and support staff. RN Coordinators. The RN coordinators are the primary recipient of the project. RN coordinators function as case managers in the delivery of care for transplant patients. The RN coordinator is responsible for patient communication, education, telephone triage and reminder communication for required testing for transplant patients. RN coordinators receive all imaging and lab results, interpret these values, communicate findings with the provider and assist with medication refills, management and education surrounding the outlined treatment plan. Nurse Educator. The Nurse educator consults with program directors (MDs) to identify barriers seen in daily practice and areas of concern they note during their follow-up visits. This information is applied to the follow-up checklist tool. Nurse educator will deliver the preintervention survey and assist with the delivery of deliverables. Lead Medical Assistant. The lead MA will gather insight from their employees regarding patient communication and the current process for follow-up education, if any is present. This information is used to identify current limitations and propose solutions. Collectively, the committee will communicate weekly in in-person meetings to allow for discussion, Collectively, the team will review evidence and contribute to the creation of the checklist for the follow-up call. Description and Development of Project Deliverables 15 Pre-Intervention Survey. The pre-intervention survey will act as a baseline measurement to gauge RN coordinators confidence and job satisfaction levels in delivering educational follow-up under their current process (see Appendix A). PowerPoint Inservice. A PowerPoint in-service will be presented as the main delivery format for the RN coordinators. This will provide clarity to the current process, need for change as well as the research supporting benefit for nurse-led follow-up education and the enhanced delivery of timely education (Timmers et al., 2020) using electronic communication. Furthermore, this will include a digital copy of the Telephone Checklist that will also be provided to the RN coordinators (see Appendix B). Nurse-Led Educational Phone Call Checklist. Implementing nurse-led educational programs not only increased provider confidence, but their effectiveness and belief in programs to change patient health and behaviors (Brathwaite et al., 2018). The checklist addresses commonly missed education points that patient being treated in the transplant clinic (see Appendix C). Areas such as importance of testing, imaging and visit follow up is addressed, as pointed out that missed appointments and tests may decrease patient outcomes and lead to worsened prognosis (Naghavi et al., 2019). This checklist operates as a guide to assist RN coordinators to address topics that patients may have questions about, or historically have not been addressed adequately. Post- Intervention Survey. The post intervention survey (see Appendix D) will be utilized to assess nursing job satisfaction and confidence with delivering educational follow-up after the implementation of the guided checklist. This tool will be used to evaluate the effectiveness of the checklist and provide areas for improvement as well as identify barriers. Timeline 16 The timeline for this MSN project (see Appendix E) is approximately six weeks. Week one will include the project lead and nurse educator meeting with clinic leadership to discuss the project plan and implementation and provide a sample of the deliverables. Following week one, the project lead, with the assistance of the nurse educator, will distribute the pre-intervention surveys during the mandatory in-service. These surveys will be delivered before the PowerPoint presentation and include all RN coordinators delivering patient care. Upon completion of this survey, the project lead will collect the pre-intervention surveys, and the nurse educator will begin the PowerPoint presentation. After the in-person in-service is completed and expectations are delivered, the RN coordinators will implement the new checklist and begin the new follow-up process. Five weeks from the date of in-service, the project lead, nurse educator, and RN coordinators will meet for an additional meeting. All RN coordinators delivering care will then complete the post-intervention survey. Following this survey, the project lead and nurse educator will gather feedback and review the post-intervention data to determine effectiveness and identify areas for improvement. Project Evaluation The project is evaluated in several ways. Prior to the mandatory education in-service, a pre-intervention survey will be delivered to gain a baseline evaluation regarding nurse confidence and current workflow. The success of the education in-service will include knowing the number of RN coordinators in attendance, and the engagement through conversation and delivery of information from the nurse educator and staff. Formative evaluation will include a random chart audit to assess for timely follow-up education documentation in the form of a nursing note on key discussion topics outlined in the telephone checklist such as disease state, 17 medications and importance of timely visits other formative evaluation occurs via biweekly team meetings to assess the current checklist flow, the effectiveness of the checklist, ease of use, average time spent utilizing the checklist, and patient and staff feedback. Six weeks following the implementation of the intervention, summative evaluation occurs through a post-intervention survey to evaluate nurse confidence and workflow and gauge any current barriers to utilizing the new program. At this time, data from prior biweekly meetings and staff feedback will be considered to make necessary adjustments to the checklist materials. Information gathered from the post-intervention survey will allow for adjustments to further improve nurse confidence and workflow. Ethical Considerations Ethical considerations ensure that all patients, regardless of prognosis, disease staging, age, gender, sexual orientation, race, or religious preferences, will be included in the implementation of this intervention. All patients will be included if they have a working telephone number listed. Nursing staff participation in the pre- and post-intervention surveys will remain voluntary and anonymous to ensure ethical considerations and prevent staff bias. Responses gathered from these surveys will be obtained and managed by the project lead, and information will not be distributed or viewed by anyone other than the project lead and nurse educator. Responses will be kept anonymous by providing writing utensils in the same color ink to ensure discretion and an option for an anonymous survey utilizing an electronic survey platform to ensure staff privacy. Discussion 18 Non-noncompliance with the agreed-upon medical treatment plan results from a variety of circumstances, all of which lead to disease progression, increased hospitalizations, readmissions, treatment failure, and potentially life-threatening outcomes (Naghavi et al., 2019). Therefore, the need to create education interventions to improve health literacy, reduce the knowledge deficit and decrease the communication gap is necessary (Schievelbein, 2020). Evidence-based Solutions for Dissemination The methods, evaluation, and significant findings of the project will be shared in a formal poster presentation with faculty and peers of the Annie Taylor Dee School of Nursing at Weber State University during the final semester of the Masters of Nursing program. Further, dissemination will take place through an oral presentation during an in-service to colleagues in the Transplant clinic and to the staff of surgical services and Kidney Transplant Associates. Significance to Advanced Nursing Practice Nursing burnout leads to increased turnover rates and, therefore, leaves a large nursing gap to replace, as well as mental health implications and workplace culture. Implementation of effective interventions to reduce nursing workload and improve workflow are shown to improve job satisfaction and improve staff retention (Niskala et al., 2020). Furthermore, the role of the Registered Nurse coordinator is to encourage shared decision making, by enhancing health literacy and allowing patients to make informed decisions about their care (Coughlin, Vernon, Hatzigeorgiou & George, 2020) implementation of a follow-up telephone call utilizing a guided checklist allows for the RN coordinator to assess knowledge deficits, provide education and close the knowledge gap therefore enhancing health literacy. Implications 19 Implementing a secondary educational phone call provides an opportunity to close an ever-present communication gap and provide enhanced education (Woods et al., 2019) to improve patient understanding and compliance, reducing nursing workload and improving nursing confidence. Project strengths include using an electronic format for patient education, mainly in the telephone format, and telephone reminder systems. A primary checklist ensures accuracy and provides a standard tool utilized amongst all nurse coordinators in the department. Discussions about chart audits to ensure the checklist is utilized appropriately, in addition to real-time observation of nursing workflow, increases awareness and improves expectations. Leadership support will also enhance buy-in from nurse coordinators, and continual feedback should be inquired to ensure that the checklist tool remains effective and provides benefits to both nursing staff and patients. Limitations for the implementation of the project include possible lack of engagement, time constraints to complete phone call, language barriers, and decreased interest from either patient or nurse. One way to overcome a language barrier is to implement the use of in-person or telephone enabled interpreting service to ensure accuracy and continuity in the information being receive in the preferred spoken language of the patient Recommendations Implementation of an educational follow-up call utilizing a guided checklist is recommended to similar clinics that provide care for chronic illness. Furthermore, a registered nurse content expert, suggests utilizing a secondary education touchpoint to address disparities amongst transplant clinic patients (K. Dayton, personal communication, December 2019). Registered nurse expertise should be routinely requested to address the current checklist format and ensure further opportunities to address and close these disparities. Further, it would be 20 valuable to conduct A patient survey to determine the effectiveness of telephone guided phone calls on increasing treatment plan knowledge or medication regimen understanding, and improvement in understanding their health. Limited data is present exclusively to follow-up care modalities for specialty clinics. Majority of data collected included follow-up from emergency rooms, post-surgical services and primary care offices. Conclusions Patient noncompliance to varying factors can contribute to increased nursing effort, workload, and stress, which in turn can negatively impact patient care and contribute to poor quality of care (Dhaini et al., 2020). When nurses cannot provide quality care according to their standards, this can lead to poor self-esteem, high stress, increased burnout, and decreased confidence (Johnson et al., 2020). 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I feel confident that the time I spend educating patients about their treatment plan is effective. 1 2 Not confident 3 4 about the middle 5 confident 4. I adapt the treatment plan education to the patient’s learning style. 1 2 Not confident 3 4 about the middle 5 confident 5. I adapt the treatment plan education to the patient’s current health literacy. 1 2 Not confident 3 4 about the middle 5 confident 6. I involve the patients in decision making 1 2 Not confident 3 4 about the middle 5 confident 7. I use methods, such as teach-back to ensure patients understand their treatment plan. 1 Not confident 2 3 about the middle 4 5 confident 8. What do you feel is the biggest barrier to your current work flow? 9. What factors do you think could improve or enhance this work flow? 28 Appendix B PowerPoint Inservice 29 30 31 32 33 Appendix C Nurse-Led Educational Phone Call Checklist Please address the following information: 1. Your role a. Role of RN coordinator and how you can support their care b. Explain team members and how they will assist patient 2. Patient diagnosis a. Are you aware of why you were seen in the liver clinic? b. If so, what questions do you have about your current diagnosis 3. Modalities a. Discuss the frequency for the following: i. Labs ii. Imaging iii. Clinic visits b. Discuss the importance of attending or completing the modalities timely c. Discuss alternative options to ensure affordability and in-network coverage i. Tellica imaging ii. Labs or imaging at outside locations covered by their insurance 4. Medications a. Discuss any new medications the patient may have been started on i. Discuss the use intended for this medication ii. Re-address dosing iii. Address s/s to watch for iv. Ask and answer any questions regarding these medications 5. treatment plan a. Re-iterate the current medical plan b. Ask if patient is comfortable with this plan c. Ask if patient has any other questions 34 Appendix D Post- Intervention Survey Please answer the following questions to the best of your capability following the implementation of the nurse-led educational phone call. Rate yourself on a scale from 1 to 5. 1. I am confident in answering patient questions concerning their liver disease. 1 2 Not confident 3 4 about the middle 5 confident 2. I know where to find answers or solutions to questions I do not know the answer to. 1 2 Not confident 3 4 about the middle 5 confident 3. I feel confident that the time I spend educating patients about their treatment plan is effective. 1 2 Not confident 3 4 about the middle 5 confident 4. I adapt the treatment plan education to the patient’s learning style. 1 2 Not confident 3 4 about the middle 5 confident 5. I adapt the treatment plan education to the patient’s current health literacy. 1 2 Not confident 3 4 about the middle 5 confident 6. I involve the patients in decision making 1 2 Not confident 3 4 about the middle 5 confident 7. I use methods, such as teach-back to ensure patients understand their treatment plan. 1 Not confident 2 3 about the middle 4 5 confident 8. Has the nurse-led educational phone call and checklist improved your workflow? 9. Has the nurse-led educational phone call and checklist improved your confidence with managing treatment plans? 35 10. Please provide any other suggestions 36 Appendix E Project Timeline