Читать книгу 1,000 Years of Diabetes Wisdom - David G. Marrero - Страница 12

by Theresa Garnero, nurse, San Francisco, CA

Setting personal goals is the cornerstone of diabetes self-management education. We are taught about the importance of helping people be realistic with their plans. In repeated individual and group settings, I thought I was supporting a science-based approach of change theory by dissuading folks not to overdo it when they set a goal. One person changed all of that.

Kristen and I met during an individual assessment after she was newly diagnosed with type 2 diabetes. Her anger was ubiquitous. My attempts to soften the blow of her diagnosis through the use of gentle humor didn’t faze her. Her partner responded positively, but not Kristen. After she left this first educational encounter, I wondered if we connected at all, and seriously doubted she’d return to class.

A few weeks later, Kristen did show up for class. She hardly made eye contact and only spoke when direct questions were asked. She seemed overall disengaged. Kristen was struggling with the acceptance of her diagnosis. When it came time to set a personal, self-care management goal, she chose to exercise at 60 minutes a day, every day. Since she had not been exercising at all, this goal went well above what was considered realistic. I tried all the typical statements, “How about starting out with making small changes, then build up to an hour a day?” and “If you set a goal, for example, of exercising three times a week for 30 minutes, then if you do more than that, you would exceed your goal.” She wouldn’t budge, until I muscled my way into her changing her goal to 30 minutes of walking, five times a week.

Over the next few weeks, Kristen continued to return to class, showing she had met her unrealistic goal of walking an hour a day, every day. She was losing weight. She was less angry, interacted with other participants, and even started to laugh at some of the class-driven humor. I thought that it was great to see someone who made such a dramatic change in their self-care behavior and didn’t give it much thought. Months later, well after the completion of the diabetes program, the phone rang.

Kristen called to say, “I’m calling to thank you and let you know that you really pissed me off.” She caught me completely off guard. After working with her over the course of the program, I felt we had developed a strong connection and contributing to her anger was not something I would have ever guessed. She explained, “When I was making exercise a personal goal, I felt you didn’t have any confidence in me. I knew you wanted me to succeed, and my logical mind knew that you didn’t want to see me set myself up to fail, but it pissed me off. I thought ‘I’ll show her. I’m going to exercise every day for 60 minutes!’ and I did. Now it feels great to exercise every day. You helped me to turn over a new leaf. I have a new lease on life. Thanks for pissing me off.” We shared a little laugh. I apologized for being too rigid, and it got me thinking.

It goes to show that we never really know how we can affect someone’s life. Kristen reminded me the importance of partnering with a person on his or her journey instead of pushing an agenda in the name of what science shows is best. I lost sight of the individual in this scenario. I did not allow Kristen to discover what would work best for her, at her pace, on her terms. Personal goals are just that—personal. Now if someone sets a goal to what I assess as being unrealistic, I still provide the information about making small changes over time, but I don’t push it. I make sure that person decides which route to take.