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Tough Battle, Compassionate Coach



For patients with chronic disease, life can become a desperate battleground. Every day brings more struggle, more loss. Meanwhile the diabetes worsens, the hypertension increases, the depression hangs on...

Bev Twedt, RN health coach at Sanford Internal Medicine in Fargo, refused to sit on the sideline.

“I love people,” she says. “I want to help.”

An exam room moment

With a gentle voice and open smile, Bev enters the exam room immediately after a critical conversation has taken place between a doctor and a patient. The doctor has recommended steps to improve the patient’s life and health, including fewer medical complications and ER visits.

But the steps are difficult -- weight loss, no smoking, exercise, better diabetes control and others.

“Patients hear the words, but don’t know where to start,” says Bev. “Through a process called motivational interviewing, we find out what’s important to them and what they’re willing to change. We help them set their own goals, develop a plan and connect with tools and resources. It’s amazing what can happen when it’s their agenda, not ours!”

Bev and other RN health coaches learned motivational interviewing from a Sanford psychologist. The proven technique focuses on open-ended questions, careful listening and reflective responses.

“It’s so easy to make the fast judgment -- why don’t patients just stop smoking? Lose weight? Get some exercise?” says Bev. “But when you put yourself in their shoes and understand their circumstances, you’re less likely to judge. Inside every person there’s a needy human being who deserves to have somebody care about them and help them.”

Bringing compassion to every setting

A 1980 graduate of St. Luke’s School of Nursing in Fargo, Bev still remembers the words of one of her instructors: The straight-A nurse is not necessarily the best nurse.

“To me that meant you can learn the technical skills, but you can’t learn compassion,” says Bev. “And you need compassion to be an effective nurse. Patients can feel the difference when you really care about them -- and when you don’t.”

Throughout her nursing career, in all settings, Bev has made compassion her constant companion:

  • In her 20s, she cared for the tiniest patients in Sanford Children’s Neonatal Intensive Care Unit. “You get close to the families, too,” she says.
  • In her 30s, she moved to a rural area and put her skills to work in a nursing home. “That’s when I discovered I loved working with the elderly,” she says. “There’s so much they can share with you and so much you can learn from them.”
  • In her 40s, she returned to Fargo and worked with adolescents in a mental health setting. “That’s when I learned that if you can’t meet the mental health needs of a patient, you won’t get far in meeting their physical needs,” she says. “You have to care for the whole person.”
  • Innovating and growing

    In 2002 Bev joined Sanford Internal Medicine -- a department known for advancing new strategies in patient care. A lead nurse for several years, she participated in a care management pilot project that opened the door to fulltime care management.

    “That’s where my heart is,” she says. “I’m energized when I can help patients grow, improve their health and live their best life. Their successes inspire me.”

    In recent years, care management and health coaching have evolved into “Medical Home” -- an up-and-coming team approach to care. Team members include the doctor, nurse, RN health coach and patient. The team works closely with Sanford Psychiatry to ensure mental health needs are met.

    “Medical Home is an exciting, important way to care for patients,” says Bev. “Even if they just need encouragement, patients know where to turn. It’s neat to be part of something like this.”

    Family matters

    While patients benefit from their positive connection with Bev, Bev benefits from her positive connection with coworkers.

    “Whether it’s your family at home or your professional family at work, everything goes better when you have good communication and trust,” she says. “You know you can rely on each other.”

    Like all families, Bev and her coworkers share favorite moments. She recalls a gentleman who desperately needed to lose weight, but was frustrated by many failed attempts. Through health coaching, Bev connected him with the program he needed.

    “He came in to see us after losing 167 pounds. He was like a different guy -- so proud of himself and what he’d accomplished,” she says. “You just wanted to rejoice with him.”

    It starts with love

    Legendary football coach Eddie Robinson once said, “Coaching is a profession of love. You can’t coach people unless you love them.”

    Three cheers to Bev and all Sanford nurses who bring compassion, connection and caring to their chosen field.

    Patients win!

    Posted Date: September 2012

    Tough Battle, Compassionate Coach

    “It starts with the relationship,” says Bev Twedt, RN health coach. See how she compassionately connects with patients to help them make important -- but difficult -- changes in their lives.