Nurses (and most people) “know” what to do to lead a healthy life – however, ‘knowing’ does not necessarily translate into action! This raises the question – why don’t we do what we know needs to be done? (i.e. quit smoking, lose weight, move more, drink less). Until we know and address the “why”, then the behaviour change is often short-lived and unsustainable.
Many respondents in the survey commented that “I know I should lose weight”, “I wish I could quit (smoking)”, “I can’t believe that I don’t look after myself properly” and “I’m good at telling my patients what to do – I just wish I could do it for myself”.
There are many programs out there and some do address the “why” of lifestyle risk factors (e.g. Mindfulness). However, many other programs focus on the symptoms (weight gain, smoking, drinking too much alcohol) without addressing why it is happening for that person. In this article I discuss an example of working with a client to address the “why” of her smoking.
To do this, I demonstrate the use of a tool from Motivational Interviewing (Velicer, Prochaska, & DiClemente, 1985), which came from research into “Change Theory”. This is based on asking four questions that can help to identify the “why”;
1. What are the advantages of changing?
2. What are the disadvantages of changing?
3. What are the advantages of not changing?
4. What are the disadvantages of not changing?
Let’s look at # 3 one in more detail – I will base this on an actual client, Sue (not her real name), a 42-year-old single mother, working as an RN in the Chronic Disease Outpatient Clinic at the local hospital. Sue smokes 10-15 cigarettes/day and has quit numerous times only to start smoking again when things “get tough!”
I asked Sue to tell me all the advantages of “not quitting”, of “continuing to smoke”! Initially Sue could not think of any. She said “no, I HAVE to quit. I want to be a role model for my kids and my patients. I need to get healthy and I hate being out of breath and not being as active as I’d like.”
With some prompting, Sue was able to talk about some of the advantages of NOT quitting;
· I get smoko breaks at work where I walk across the road to meet up with the others who smoke – if I quit I couldn’t do that anymore
· I get to hang out with my friends who smoke and I like doing that
· I sometimes feel like a rebel when I smoke
· It’s just who I am – I have smoked most of my adult life
· I can just keep on doing what I do
· It’s a great stress reliever
· It’s hard work to quit – if I just keep on smoking then I don’t need to think about it.
I encouraged Sue to brainstorm at least 20 more “advantages” of not-quitting – this took her some time and she took her list home with her so that she could add to it. Sue expressed surprise at the “advantages of not quitting that she came up with!” She said that she’s never thought about it before and “yes” these were some of the reasons that she kept smoking! Working with Sue to identify these and then address them was a pivotal point in her decision to quit. Talking about the “elephant in the room” meant that Sue was aware of the reasons why she continued to smoke and addressing these gave her “permission” to turn these around and do something different! Sue found it easy to list all of the reasons why she “SHOULD” quit, but until she faced the other side (why she shouldn’t quit), Sue was in danger of repeating the past by quitting for a short-time and then starting up again! This time we addressed all the reasons why she shouldn’t quit and developed ways of dealing with these. She then had the strategies and tools in place, ready to deal with her own issues on the way to becoming a non-smoker!
The challenge is to support clients to address the “why” by asking the question “what are the advantages of (not changing)?” Once we can explore this and delve deeper into what is keeping the client where they are, the better we’ll be able to encourage them to make the change! The “why” is the impetus for change!
If you would like more information on using “Motivational Interviewing” then click this link to enrol
Velicer, W., Prochaska, J. Q., & DiClemente, C. C. (1985). Decisional Balance Measure for Assessing and Predicting Smoking Status. Journal of Personality and Social Psychology, 1279-1289.