Career advice

Change for the better

Nurses are in an ideal position to use the simple technique of questioning to help patients change their health behaviours.

Most people know what they should or should not be doing for their health, and sometimes they just need a gentle reminder. Through empathetic questioning, nurses can extend the holistic approach to their role as educator.

To change their behaviour, a patient first needs to be convinced that the change will make a difference to their health and be confident they can adapt their behaviour to achieve a successful outcome.

The nurse can use questions to explore whether the patient is motivated to change, followed by questions exploring their plans for action (see box). During the action stage, the nurse can help ensure change goals are SMART, that is: specific, measurable, achievable, realistic and time-bound.

Avoid closed questions requiring a yes or no answer – these can be a conversation-stopper. Encourage the patient to speak about their problem.

Avoid questions with only two options. Instead, for example, try asking a smoker how they feel when they have a cigarette, to prompt a more reflective conversation.

Avoid questions about biomedical factors only. Discussing the emotional causes of poor health behaviours helps the patient to start making change.

Avoid judgemental or clichéd words, such as ‘obviously’ and ‘it’s a fact’. The patient knows they should change, but they need to acknowledge this themselves.

It is easy to initiate health education, but much harder to create a bond where a patient will open up about their fears of changing their behaviour. A nurse can create this bond by:

Adopting a non-judgemental attitude and listening to the patient with empathy.

Using reflective listening and identifying underlying emotions behind the answers to questions.

Remembering that non-verbal communication is important. Make eye contact, lean in towards a patient and give undivided attention.

Successful transition from health education to health promotion depends on the patient deciding to alter poor choices and take the first steps. You will have been successful if your questions lead to just the consideration of behaviour change.

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