Primary health nurse practitioner ROSEMARY MINTO on the challenge of "flicking the switch" to good health habits and the need to realise the 'story' behind each reluctant quitter or non-exerciser. Plus the need to be funded to give the time required to support people make and maintain lifestyle change – particularly with the low levels of health literacy.
Sometimes when I sit down with a patient at their home or in the clinic I just know that whatever I say will not convince them to reconsider their lifestyle.
However I describe how their lifestyle choices are affecting or threatening their health, they will refute my knowledge, with their own worldview acting as a barrier to understanding or acceptance.
One of my biggest challenges, and one I continually face, is how to reach through to people with chronic conditions or at high risk of poor health. How to help them "flick the switch” from unhealthy lifestyle choices - be it smoking, daily fast food, no exercise, alcohol, drug taking or any combination of those - and change their attitude to their health.
I have had more than one patient tell me that one of the reasons they attend appointments so infrequently is because they are “sick of being told off”.
I have recently had the privilege to present at the College of Emergency Nurses conference. My chosen topic was integration, mainly because of my conviction that this work will be truly useful in moving our health systems towards improving the patient’s journey.
During the conference Marama Tauranga, an emergency department (ED) clinical nurse leader introduced her research which describes, amongst other things, the danger of assuming that a 'single story' exists when people present to the ED. Marama discussed the multiplicity of stories that make up a person’s experience and the importance of recognising this when we care for them.
Educated informed consent
This reminded me of a woman I have seen who always refused blood tests for a cardiovascular risk assessment or other diagnostic purposes. I asked, very respectfully, if she could tell me why she was declining the tests I was recommending. Her answer was that she didn’t wish to have the control of her health and destiny wrested away from her. She said she had seen too many of her whānauin hospital with no apparent control over their destiny. It seems she connected having any investigations with this outcome.
As a health professional I felt abhorrence that any patient would feel like they have no control over how they fare in hospital- however I am aware that is indeed peoples’ experiences. How we as nurses change this reality is in the way we explore and then acknowledge a person’s health beliefs and the effects of their life experiences -their “stories" as Marama Tauranga's research showed. And we need to respect that, with informed consent, patients have the right to make decisions as they see fit.
Informed consent is in itself a challenge as it assumes that the person giving consent has sufficient understanding of the health condition and the consequences of the consent, that is sufficient health literacy.
Health literacy is defined as "the ability to obtain, process, and understand basic health information and services to make appropriate health decisions”. A breakdown of 2006 New Zealand adult literacy statistics found poor health literacy in 56% of the 7,000 adults surveyed. Four out of five Māori males and three out of four Māori females had poor health literacy skills and across all household income quintiles Maori had worse health literacy than non-Maori. This population is also the one with the poorer health outcomes - no surprises there.
Funding is being distributed towards programmes that funders' hope will make a difference to our current health statistics. For example the National Government has promised a $40 million anti-obesity programme, Healthy Families NZ, which will provide $6 million for primary care intervention teams, offering nutrition and lifestyle advice.
However well funded any programme is, the challenge for the providers will be to incorporate health literacy concepts into the programme, to make them truly user friendly. We can’t 'make' patients 'do' anything and nor should we want to - that technique belongs where it should - in the paternalistic past.
We can only educate and support them towards healthier choices. But it takes time, for providers to learn how, and for patients to make and maintain the changes. Hopefully any future funding will recognise this.
References: Ministry of Health. 2010. Korero Marama: Health Literacy and Māori, Results from the 2006 Adult Literacy and Life Skills Survey. Wellington: Ministry of Health
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