clinical question

SuesquatchRN, BSN, RN · Jul 27, 2008

Well, I'm an LPN, but have had success with men by explaining that most anti-hypertensives and cardiac meds can have the effect of turning a mighty oak into a teeny, soft sapling, as can the side effects of uncontrolled diabetes.

Seriously, it sometimes works.

Joan Z · Jul 27, 2008

I like it! Will definitely have to remember that line...

I'm also looking to hear of any success stories about decreasing BP or LDL using diet/exercise/meditation.

Thanks.

JDCitizen · Jul 27, 2008

Well, I'm an LPN, but have had success with men by explaining that most anti-hypertensives and cardiac meds can have the effect of turning a mighty oak into a teeny, soft sapling, as can the side effects of uncontrolled diabetes.
Seriously, it sometimes works.

Well have not used that exact line :clown: :chuckle :bow:but when I am talking with my patients I don't mince words ( especially to those who appear noncompliant with therapy)..

Diabetics and HTN: I do use “you do like having sex?” Or “look at your toes… those are usually the first to go”…

By the way great question.. One of the few direct patient questions Iv see here.. Although I am not at 100% knowledge of this site...

It’s all about risk / benefits, it’s about being proactive: By trying to put it into terms the patient can understand by giving them as vivid of a mind picture possible.

I have seen what losing 20+ pounds, through life style modifications, can do in a patient's life.

VivaRN · Jul 27, 2008

I'm an NP student, but I've definitely had success with recommending these things! One patient in particular, I remember, came into the office 3 months after his HTN dx and was so excited to have lost weight. He told me all about his walking plan, new eating habits and how this dx was the "kick in the pants" he needed to change his life. He did well and did not need medication. Same thing with another woman dx'd with metabolic syndrome. Both of these individuals were homeless.

I've found that it doesn't work to just spout off "diet and exercise", you have to take into account the person's culture, eating habits, what activities they are able to do, INVOLVE THEM IN THE PLAN, show that you care about them, and start slow so they can feel successful. If you don't do these things... is it really so surprising that most people don't do it? Would you?

Health education research has shown it helps for people to feel that 1) they are at risk (increased perceived risk) and 2) that they can do something about it (increased self-efficacy) to change behavior. There is so much research on this subject I almost wish providers would look at it instead of getting frustrated. If you've ever tried to change your behavior you know it's HARD - even for those of us with adequate time and resources. I praise people for every little thing... "I'm so glad you came in today, look at you taking charge of your health."

As NP's this is an area where we excel - pt. education is nothing new for nurses. I love that we can use our skills to keep people healthy and out of the hospital.

JDCitizen · Jul 27, 2008

i'm an np student, but i've definitely had success with recommending these things! one patient in particular, i remember, came into the office 3 months after his htn dx and was so excited to have lost weight. he told me all about his walking plan, new eating habits and how this dx was the "kick in the pants" he needed to change his life. he did well and did not need medication. same thing with another woman dx'd with metabolic syndrome. both of these individuals were homeless.
i've found that it doesn't work to just spout off "diet and exercise", you have to take into account the person's culture, eating habits, what activities they are able to do, involve them in the plan, show that you care about them, and start slow so they can feel successful. if you don't do these things... is it really so surprising that most people don't do it? would you?
health education research has shown it helps for people to feel that 1) they are at risk (increased perceived risk) and 2) that they can do something about it (increased self-efficacy) to change behavior. there is so much research on this subject i almost wish providers would look at it instead of getting frustrated. if you've ever tried to change your behavior you know it's hard - even for those of us with adequate time and resources. i praise people for every little thing... "i'm so glad you came in today, look at you taking charge of your health."
as np's this is an area where we excel - pt. education is nothing new for nurses. i love that we can use our skills to keep people healthy and out of the hospital.

no comment necessary; except nicely summed up...

Joan Z · Jul 27, 2008

I agree, nicely put. I would suspect that this would be a major reason for not implementing all those TLCs.

I also agree, you need to get them where they have the most emotional investment--toes, sex life, whatever.

SuesquatchRN, BSN, RN · Jul 27, 2008

People need to be invested in improving their health and I find that if you can find something they value that will improve if they can change their behavior, even a little, baby steps can be taken.

I know, for me, that I was a very heavy smoker and it took being off cigarettes for a few months before I realized that most people didn't feel awful all the time.

Remarkable.

DaisyRN, ACNP · Jul 29, 2008

i agree with the other posters... you have to involve the patient. acknowledge their strengths as well and play on those. the key idea behind your inquisition is that as nps, we are expected to fulfill a teaching role. that is what we do and this is largely where we excel. i've mentioned it in other postings about my new job with cardiology, but the md (as excellent as a physician as he is) just does not take the time to talk about lifestyle changes like i do. the patients truly have voiced value in what i tell them... he scares the pants off of them about smoking, but other than that... he's just very brief. he doesn't give them time to ask questions or clarify information. generally speaking, i think nps are more approachable.

other tips? congratulate successes, regardless of how small. provide them with resources of healthy changes, i.e. discounts to the gym, home work out suggestions, good recipes, stress relieving tactics, etc. if they feel like you truly care about them, then they will begin to take pride in themselves and make better choices.

as i am working on healthier changes myself, i will be straight up with a patient... and say "look. i am doing this with ya... i know it is not easy to lose weight and exercise..." from a personal level. i'll share little things i have learned along the way, or share healthy yummy food options that i have discovered. i just don't feel comfortable being overweight and pointing my finger at someone else saying "dont eat that. don't smoke that (although i quit *ahem*), exercise" etc etc. if they see me taking pride in what i do and making changes... and make it feel like we are working on this together, they seem to be more accepting and eager to make changes.

also, try to keep it lighthearted. sure, i give my patients a hard time if they need a good swift kick in the butt, but only on those patients that i know would give me a hard time back. :) but they know when i'm serious... and they know i truly am concerned for their well-being.

oh... almost forgot: and don't wait on the patient to bring anything up... especially uncomfortable topics, like sex. if you bring it up first, they often find relief in not sitting there wondering how they are going to ask and end up not hearing anything you have said up to that point. lol

Trauma Columnist · Jul 29, 2008

I work with ESRD chronic hemodialysis patients. Being noncompliant (for most of them) is what led them to dialysis. It is a tough sell to get buy-in from my patients. One of the units I work in is inner city, several homeless patients, many indigent patients. You must first gain their trust (and that can take a while - lol). Then, and only then, can you get the buy-in from them. Also, consider illiteracy, low literacy and English as their second language. All barriers to teaching.

JDCitizen · Jul 29, 2008

I work with ESRD chronic hemodialysis patients. Being noncompliant (for most of them) is what led them to dialysis. It is a tough sell to get buy-in from my patients. One of the units I work in is inner city, several homeless patients, many indigent patients. You must first gain their trust (and that can take a while - lol). Then, and only then, can you get the buy-in from them. Also, consider illiteracy, low literacy and English as their second language. All barriers to teaching.

You know I was reading this more than a few of my patient's noncompliance issues are related to money (lack of)... Choices of one or two but not all: Pay the rent, eat or buy my medicines. What they eat, how they work, their very life is sometimes shaped by finances or lack of... Always a hard part for me to remember...

I worked with a group that was mixed hospitalist / nephrology and some of the clientele it was very hard to determine noncompliance by choice or noncompliance by necessity... Finances, literacy, nationality and more than a few times religion have thrown big curve balls into medical planning....

Joan Z · Jul 29, 2008

DaisyRN--I quit smoking many times before quitting for good a few years ago, but will never say never--I still hear that nicotine siren song every now and then! So yeah, I agree it helps to say "I'm in there with ya". Maybe it is the nursing background but is it easier for a NP to admit personal imperfection? I have never heard a MD or DO say "yeah, I'm too fat too, but I'm working on it."