By Debra Wood, RN, contributor
June 11, 2010 - Although it may be difficult, change can lead to improved quality of life when people adopt healthier lifestyle choices. Patients often grant nurses the opportunity to influence their choices, and when we approach subjects such as smoking cessation, healthy eating or exercise in the right way, nurses can make a difference in people’s lives.
“Patient teaching is such an important role for nurses,” said Hila Richardson, RN, DrPH, MPH, BSN, professor and director of the undergraduate, continuing education and community health programs at New York University College of Nursing. “Most chronic diseases require management for the rest of their lives.”
Bernadette Melnyk, Ph.D., RN, CPNP/PMHNP,FNAP, FAAN, reports that changing people’s thoughts is an importantstep in changing behavior.
Yet changing behavior is a very complex process and requires more than sharing of information, added Bernadette Melnyk, Ph.D., RN, CPNP/PMHNP, FNAP, FAAN, dean and distinguished foundation professor in nursing at Arizona State University College of Nursing and Health Innovation in Phoenix. Her research indicates success comes from combining cognitive behavioral skills building with education.
Motivating patients to take better care of their health requires a multifocal, caring approach, beginning with the nurse bringing the right attitude.
Here are 10 tips for helping patients change their poor health habits:
1. Establish the right mindset. Nurses learn in school not to judge patients, but it’s hard to check biases at the door. A study by Rebecca Puhl and colleagues at the Rudd Center for Food Policy and Obesity at Yale University in New Haven, Connecticut, found that 46 percent of overweight people surveyed reported weight bias from nurses and 69 percent from doctors. The Rudd Center recommends nurses become more self-aware of their attitudes toward obesity and avoid hurtful terminology.
Mindset and bias about aging are factors when working with older adults, reports Barbara Resnick, Ph.D., RN, CRNP, FAAN, FAANP, professor and co-director of the Adult Nurse Practitioner/Gerontological Nurse Practitioner combined program at the University of Maryland School of Nursing in Baltimore.
Barbara Resnick, Ph.D., RN, CRNP, FAAN, FAANP, encourages nurses to appreciate what older adults can do and help them achieve their goals, perhaps modifying an exercise program to eliminate associated pain.
“Philosophy is number one,” said Resnick, adding that nurses with the right outlook about aging can help older people learn to optimize their lives.
2. Capitalize on teachable moments. Becoming ill enough to require hospital care for a disease or its complication can motivate some patients to change, said Susan McLaughlin, RN, CDE, an inpatient diabetes educator at the University of Chicago Medical Center.
3. Actively listen. The most important thing a nurse can do is take an extra five minutes to sit with patients and listen to where they are coming from, and their concerns, advised Peggy Hasenauer, MS, RN, executive director of the University of Chicago Kovler Diabetes Center.
“Listening is the best way to help them on a path to healthier lifestyles,” Hasenauer said. “Nurses can be therapeutic.”
4. Assess the patient’s knowledge level. Start with finding out how much the patient knows and some of the barriers he or she faces in managing the condition. A lack of money or frustration with past failed attempts to control blood sugar or lose weight may deter someone from giving it another try.
“Many people think it’s too late to make changes,” McLaughlin added. “Some older patients feel it’s pointless [to try to change behaviors].”
Resnick said that, for the most part, people know what constitute healthy habits, but they continue to make unhealthy choices. That may be because it feels good or the unhealthy option is easier.
5. Determine what’s important to the patient. In addition to finding out what they know, dig a little deeper to assess what they care about, added Deborah Poling, Ph.Dc., APRN, BC, FNP, an associate professor at the Metropolitan State College of Denver
Department of Nursing. Some people want to stay active and might be willing to exercise to keep the ability to get out and about.
Some patients may lift weights so they can continue to carry their own groceries, Resnick added. Nurses need to find out what the patient wants. Typically, people will not change simply because something is good for them. It has to provide positive benefit in their lives.
6. Emphasize the short-term benefits. McLaughlin talks with patients about how much better the person will feel if they follow the recommended plan of care.
“If you threaten them with loosing limbs or eyesight, research shows it’s not effective. It doesn’t change behavior,” McLaughlin said. “Most people want to feel good and have energy to enjoy their life.”
7. Manage the comorbidities. Nurses also must help overcome unpleasant sensations associated with healthier habits, Resnick said. That might include managing arthritis pain or matching the person to an exercise that won’t increase the person’s discomfort.
Depression often accompanies chronic illness, which nurses should not ignore. McLaughlin recommends referring those patients for mental-health counseling.
“If you don’t deal with depression nothing else is going to matter,” she said. “You have to be a detective and figure out what is really happening, where they are coming from, and that’s where you start.”
Melnyk agreed, saying that unless you tackle the depression or anxiety all the education in the world will not translate to behavior changes. She finds teens and adults often overeat due to stress and anxiety. Her research data indicates overweight children often have a high percentage of depression and anxiety.
8. Consider a cognitive behavioral approach. Cognitive behavioral skills building works at helping the person change thoughts and beliefs, which in turn affects behavior, Melnyk said. She suggested that the missing ingredient in many healthy lifestyle programs is cognitive behavioral skills building.
The COPE/Healthy Lifestyles TEEN program at Arizona State University has resulted in healthier choices by teens.
“It teaches people how to reframe their thinking, so they feel better about themselves, manage their emotions better and engage in healthier behaviors,” Melnyk said.
The pilot COPE (Creating Opportunities for Personal Empowerment) /Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, and Nutrition) Program, conducted by Melnyk and funded by the National Institutes of Health, combined education about healthy habits with cognitive behavioral techniques to learn how to more positively view negative events and situations. The data showed that adolescents taking the program have stronger healthy life beliefs; are making healthier choices, such as exercising more; and have fewer depressive symptoms. Now she is researching whether the teen can serve as an agent of change for the rest of the family.
9. Involve patients in setting their own reachable goals. The person has to believe he or she can achieve the goals, said McLaughlin, who suggests creating a chart to help measure success and reconvening to go over the results.
10. Support even small successes. Provide a lot of positive reinforcement when the patient does something positive, recommended Poling. Appreciate the baby steps the person has taken.
“It’s helping someone believe, ‘You can do this,’” Resnick added. If the nurse shows confidence in the person, he or she is more likely to try or keep trying. Then check back to see if the person followed through and heap on praise when they accomplish a goal.
“It’s the follow-up and the caring,” Resnick concluded. “Nothing motivates you as much as knowing someone cares.”
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