How to Facilitate Positive Patient Outcomes in Nursing
By NT Contributor on Mon, Nov 18, 2013, as published by Nursetogether.com on 11/18/13
As nurses, we know that patient education and compliance are key components in chronic disease management. Yet motivating a patient to change their behavior to create a positive outcome can be challenging.
Take the example of Mr. Johnson. He is re-admitted to your unit for the third time in two months due to persistent elevated blood glucose level and chronic foot ulceration. He has Type 2 Diabetes and is insulin dependent. He is also a smoker and is 100 pounds over the normal weight for his height.
You have approached him several times regarding the importance of managing his blood sugar, smoking cessation, weight reduction and healthy lifestyle habits. Unfortunately, Mr. Johnson has an “I don’t care” attitude and even joked, “That’s what my doctors are for.”
How can you facilitate positive outcomes when faced with resistance from your patients?
Recent literature suggests this can be done by shifting the approach from “outside-in” to “inside-out”.(1)This transfers the role of the behavior change agent from the clinician (i.e. nurse or physician) to the patient.
Typically, we provide evidence-based information and advice to our patients by way of informational pamphlets, videos, and/or verbal discussion, including setting behavioral goals for them. For example, you leave the pamphlet about diabetic foot care and tell Mr. Johnson to read about it. Or tell him that smoking is bad for his blood vessels and circulation so you are going to suggest restricting his smoking from 10 cigarettes to 5 per day, as a starting point to his smoke cessation program. Then you offer yet another pamphlet on smoking cessation. This is the “outside-in” approach.
The inside-out approach suggests that we reverse that role and allow our patients to be the party in control(1). With this concept, the nurse takes on the role of influencing the behavior change rather than pushing information onto the patient to change their ways. You would become the “influencer.”(2)
To encourage your patients to adopt new behaviors, they need to believe that they can do it. They need to believe that it is worth their time(2)and they may even need to believe that it’s their idea. Here are some tips to help you “influence” patients to reach a positive outcome.
1. Embrace the lack of control.
You have no control in the level of patient education and compliance but can influence them greatly. In order to influence their perceptions about behavior change, you must identify the patient as the decision-maker and validate their ability to control their own behavior.
For example, try presenting these options to Mr. Johnson during his treatment discussion. “Mr. Johnson, I need your help to make some important decisions about how you could take better care of your diabetes at home. Would you be interested in talking more about it today? Or perhaps you would like to think about a couple of main concerns and I could come back tomorrow to discuss them with you.”
This approach empowers Mr. Johnson as the decision-maker and invites him to engage and examine his own motives, values, belief, and experiences affecting his behavior. Recognizing the patient as the decision-maker in care compliance also reflects the fundamental concept of the right to self-determination or autonomy, one of the basic ethical principles in nursing. A patient who makes their own decisions is more committed to the outcome and has buy-in and ownership for the needed behavior modification.
2. Use questions.
Verbal persuasion can create pressure and resistance. Questions, on the other hand, are a technique for exercising influence in a non-confrontational manner. Questions capture the attention of the patient and reinforce their role as the decision-maker. As the person asking the questions, nurses can influence the direction of the discussion, gain information, and explore areas of concern and new ideas through strategic questioning.
Carefully chosen words, delivered in a sensitive, non-judgmental, respectful and non-threatening manner can disarm the patient. These make them more open to consider a change. Questions invite participation because the recipient owns their opinion or choice. In Mr. Johnson’s case, how can you motivate him to monitor his blood sugar better?
Mr. Johnson has to be ready and motivated to change. You can influence this motivation by asking appropriate questions. You may ask, “Mr. Johnson, your blood sugar level has been fluctuating greatly when you are at home and this can be very dangerous. What do you think is causing the fluctuations? What do you think would be helpful to allow you to manage your diabetes? How to you feel about finger stick testing more often?”
A change of heart can’t be imposed or dictated, it can only be chosen. This approach may be time consuming. But with the utilization of these simple techniques of influence, nurses may empower patients who are otherwise resistant to change. Patients will own their behavior and make better choices about their health.
By Angie Jung, RN, BSN, CRRN, CCM, CareerSmart® Learning
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- Botelho, Rick. Motivate Healthy Habits/ The Concept of Motivational Practice. Retrieved on 10/13/13 from http://www.motivatehealthyhabits.com/html/for-professionals/mp-concept-paper.html
- Patterson, Greeny, et al: Influencer, the Power to Change Anything, McGraw Hill Companies, 2008
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