ACT-RN: The Nurse as Behavioral Change Coach

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    Within ACBS are Special Interest Groups, and nursing now has one: ACT-Related Nursing (ACT-RN). In a melding of nursing care and psychological research, we are pursuing the nurse's role as a behavioral change coach. A vital part of our mission is to link ACT information and trainers with nurses.

    ACT-RN: The Nurse as Behavioral Change Coach

    I would love to hear from interested nurses...

    ...Dismayed, the patient looks up from her dinner, the first in her newly ordered diabetic diet. She glances down again, then asks in a moaning voice how anyone could be expected to eat like this for the rest of her life. She pushes the tray away and pulls out the table drawer to reveal her stash of sweeter fare.

    ...Further along in your rounds, you hear an impressive coughing fit and enter a room where a thinnish man is just pulling off his shoes. Despite the fact that the hospital is a no-smoking facility, a strong smell of tobacco wafts off him - it is well known that he smokes in the car with his visitors. It is also well known that he carries a COPD diagnosis. As he slowly straightens up, you notice he actually looks a little upset by his breathlessness...perhaps even frightened...

    ...Before entering the next room, you pause a moment to collect yourself. Your next patient is young, and the news today is that she isn't going to get much older. According to report, she is not taking the news very well...

    Awhile back, in any of these cases, I could manage teaching well enough. There were always the intranet printouts, and my training provided me with some basic tools to teach with. Yet the first patient already knew why she should avoid glucose spikes, and that second one had been told a million times that smoking would kill him. As for the third case, well, what was I going to teach her? How the Stages of Grief would eventually lead her to acceptance of her early death? The problem with teaching is that once the information is imparted, I am left with helping the person accept it and use it. Someone who is usually not very receptive to more teaching, more direction and advice. So, I either delegate that job, or I abdicate any responsibility for it, or I learn to coach.

    Coaching is about partnering as equals to achieve a goal. It includes teaching, and the hand-holding that nursing is so famous for, but it goes beyond these to include other tools and a different attitude skillfully applied. In my own observations and studies, it has become obvious to me that coaching for behavioral change is a nursing role. Of all healthcare professions, we are most trusted, we are on the spot most often for opportunities and crises, and we are among the most versatile.

    Of the coaching tools that I have found, those that stand out are rapport (an empathetic, supportive relationship), motivational interviewing (MI), brief interventions (BI), and Acceptance and Commitment Therapy (ACT, pronounced like the word). Taking what is needed from these four, nurses can coach at the bedside, in moments as they arise, as an extension to the teaching we are ethically and practically responsible for. And we can do it effectively, often in the time it takes to do our other assessments or change a dressing.

    I am in psychiatry now, carrying my learnings even further with primary therapy and community nursing, but it all began on the floors. Now it is the center of my masters studies, and I want to see it become commonplace in nursing.

    The Association for Contextual Behavioral Science (ACBS) is the parent organization for ACT, and membership is values-based, as in what do you think it is worth? Like the organization, ACT is about values, and psychological flexibility: the ability to accept what is. It is an empirical modality, solidly rooted in decades of evidence-based theory and research around the workings of the human mind.

    Within ACBS are Special Interest Groups, and nursing now has one: ACT-Related Nursing (ACT-RN). In a melding of nursing care and psychological research, we are pursuing the nurse's role as a behavioral change coach. A vital part of our mission is to link ACT information and trainers with nurses, which is where I reach the point of my post. I believe the people we care for need this service, and I believe we need it ourselves. We need your help.


    About ACT
    Motivational Interviewing
    Theory of Brief Interventions (pdf)
    ACT-Related Nursing (ACT-RN)
    Last edit by Joe V on Aug 8, '12
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    Darrell G King, BS, RN, CASAC-T; Rochester, NY, US;;

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    Community Mental Health Nurse; from US
    Specialty: 4 year(s) of experience in Psychiatric, MICA

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  3. by   ctmed
    In psychiatry, you have a "captive audience" so to speak, particularly on lock down psych units.

    However, for most in nursing, what you speak of may not be possible. There is a attitude towards nursing where "the customer is always right". Coaching tends to be limited to if paperwork recieved, mark yes. If patient does not follow, mark non-compliant.
  4. by   SHGR
    Great article. I am very familiar with MI and use it a lot- I will check out the other resources you have listed. It really is possible to use MI techniques in the short periods of time that nurses have at their disposal and the more familiar we become with it, the more it becomes a natural part of communication.

    It's also given me a different attitude about the so-called non-compliant patients. I think they sense that I have a different attitude about treatment adherence, because MI has given me a different vocabulary and skill set to use.

    Thanks for putting this out there.
  5. by   darrell
    I hear you, Ctmed. It can be frustrating. No captives, though: ths is about engaging with the clients, not dictating to them. Still, I agree the culture does not always support coaching. Only we can change that...
  6. by   darrell
    Similar experience here, Hey_Suz. The more I learn, the greater the difference I see in the response I get.See ya on the ACBS listservs!