Our Nurse Navigators Guide the Way and Manage Care

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Published on April 19, 2017

Our Nurse Navigators Guide the Way and Manage Care

Karen’s Story

Karen Richard and Nurse Navigator Brenda LovelyWhen Karen Richard of Pembroke met CHMG Concord Family Medicine nurse navigator Brenda Lovely in July 2014, she was not well.

For the sixth time in two months, she was hospitalized, suffering from multiple chronic conditions, chronic pain and debilitating complications, some of which were a result of multiple medications she was taking. She was seeing several specialists.

“I was very depressed and I was hurting, physically. I felt very, very alone,” Karen said.

Karen basically was confined to her home when she wasn’t in the Hospital – until Lovely got involved. She advocated for tests that determined Karen was suffering from an under-recognized condition that required an extensive medication review with several medication changes involving multiple discussions with specialists.

After Karen was discharged, Lovely helped coordinate her care through Concord Family Medicine, where her primary care team reviewed all of the pieces of her complex medical puzzle and addressed her complete medical picture.

To develop a treatment plan, Karen and Lovely talked a lot, up to five times a day by phone. The plan included connecting Karen with services, including mental health counseling, as well as changing her medication regimen and teaching skills to help her manage her chronic illnesses.

It worked. Karen has not been hospitalized for more than two years. She has successfully managed her illnesses at home with support from her Medical Home Navigation team, specialty care and mental health counseling with a social worker in the Medical Home Navigation program.

“I’m doing great,” Karen said. “I have a life that’s starting to come alive now. I can go out and do things.”

Karen and Lovely touch base once a month, but Karen knows her friend and advocate is available if she has concerns.

“When I have a problem I’m facing at home and I see myself go a little downhill, I can call and tell her what my symptoms are. She knows my background and she can talk with my doctor and between the two of them, they can come up with a plan,” Karen said. “She is a Godsend.”

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"When I have a problem I’m facing at home and I see myself go a little downhill, I can call and tell her what my symptoms are. She knows my background and she can talk with my doctor and between the two of them, they can come up with a plan. She is a Godsend.” ~ Karen Richard speaking about nurse navigator Brenda Lovely of Concord Family Medicine