Читать книгу Approaches to Behavior - Janis Roszler - Страница 9
ОглавлениеIn this chapter, you will learn the following:
● How to promote better patient and professional interactions before you meet
Have you ever seen the Ellen DeGeneres show? She has one of the most enthusiastic audiences on television. When Ellen walks out onto the stage at the start of the show, the crowd goes wild. Within minutes everyone is cheering and dancing in the aisles. How do the individual audience members, who certainly look forward to seeing the host, transform into a supercharged group? Ellen’s staff gets a lot of the credit; they greet each visitor with lots of enthusiasm, play lively music, dance, and joke around with everyone. Because they put in such an effort before the curtain goes up, Ellen gets a great response from the crowd and has a terrific show.
Who “warms up” your patients before they meet with you? Your staff. They schedule appointments and greet everyone who comes to see you. How well does your staff interact with your patients? Are they caring and attentive or rude, hostile, or indifferent? Don’t underestimate their role as your personal ambassadors. We know many patients who’ve dropped health care providers because they disliked the way they were treated by the office staff. Like you, your support staff must be able to handle difficult patients-related situations with aplomb and behave in professional ways, that is, they should never complain or argue with one another within the earshot of your patients.
Transforming Your Waiting Area
Does your waiting area communicate your healing perspective? Step into your office and look at it through your patients’ eyes. What are they likely to see, hear, and feel as they enter? Does the environment reduce stress or heighten it?
Dr. Francesca Gallarello, a Miami Beach cardiologist, transformed the small, dingy waiting area of her new office into a serene outdoor setting. She brought in sleek, white couches, a live plant arrangement, and papered the largest wall with a life-size photo of a European street scene. As patients wait, they are calmed by this soothing environment. Your office space should be clean, attractive, engaging, and relaxing. The furniture should not be worn or broken and, yes, your magazines should be current. If possible, display some form of nature, be it natural or artificial. A group of Dutch researchers examined the stress-lowering effects of real and artificial plants in a hospital waiting room. They found that “adding real or artificial natural elements to health care environments provides an unobtrusive and inexpensive stress and anxiety management method” (Beukeboom, 2012).
Take the “Wait” Out of the Waiting Area
With today’s time constraints, most patients are likely to spend a significant amount of time in waiting rooms. Unfortunately, longer wait times are associated with reduced patient satisfaction (Anderson, 2007). Those who must wait a long time to see you are more likely to be upset, impatient, and angry by the time you finally do meet. It is certainly appropriate to thank them for their patience, but because lengthy waits are often unavoidable, try to use the time to educate your patients and help them prepare to meet with you.
One way to utilize the wait time is to physically prepare your patients to be as alert as possible when they interact with you. If you work with individuals who have diabetes, check their blood glucose level as soon as they arrive. Most offices check glucose levels after patients get assigned to an exam room. Shortly after that, you, their health care provider, usually will enter the room. If a patient has a low glucose level, he or she won’t have adequate time to improve it before seeing you, so you may end up interacting with someone who can’t give you undivided attention. Some of your messages will reach their intended target, whereas others may be missed entirely. If your patients get their blood checked when they sign in, they should have adequate time to respond to a snack or take a corrective dose of insulin, if needed. If they don’t have a snack handy, provide one along with a handout on how to treat hypoglycemia. By the time the two of you meet, your patient’s glucose level should be within, or at least closer to a desired target range, which should help you both communicate more effectively.
Educate
Transform your waiting room into an extension of your treatment. Many health care providers do this. They display informative brochures, hang posters, and even mount televisions that run educational programming (Gignon, 2012). These are helpful tools that add value to the waiting room experience. But, they are passive activities. For more active learning, invite your patients to complete worksheets that heighten their self-awareness, challenge negative beliefs, help them identify strengths, and utilize their problem-solving skills. Near the worksheets, post the following: “Your appointment starts now. Please fill out these forms.”
Setting the Agenda
We designed the following worksheets for you to use in your waiting area. They contain thought-provoking questions that can help your patients consider their medically related psychological, social, and behavioral issues in a more positive and proactive way. These sheets aren’t just busy work. Writing about stressful experiences and health-related issues can speed up healing (Smyth, 1999). Expressive writing also helps many individuals enjoy improvements in their mood, emotional and physical symptoms, and immune system functioning (Baikie, 2005). If desired, use these worksheets to set the agenda for the appointment. If you don’t want to use them in that way, try to acknowledge your patients’ effort. Patients want you to take an interest in what they’ve accomplished or learned. Your inquiry doesn’t have to take up a lot of time. Simply ask your patients to name one or two things they gained from doing this activity.
Some of these worksheets are diabetes focused and are based on the American Association of Diabetes Educators’ list (the AADE7™) of seven self-care behaviors: healthy eating, being active, monitoring, taking medications, problem solving, healthy coping, and reducing risks. Several worksheets cover generic health-related issues. If you deal with a different area of medicine or have other topics you would like to address, create worksheets of your own. For example, you can develop worksheets on intimacy, humor, body image, relapse challenges, and motivation. Use simple, clear language to accommodate patients with reading difficulties and be sure to include questions that help your patients access their problem-solving strengths.
Worksheet Theme Guide
Worksheet 3. Power of Positive Thinking
Worksheet 4. Setting Personal Goals
Worksheet 6. Dealing With Stress
Worksheet 9. Monitoring Blood Glucose
Worksheet 10. Feeling Overwhelmed or Frustrated
Worksheet 11. Learning New Skills
Worksheet 12. Understanding the Positive Power of the Diabetes Police
Did you know that … when friends, family, and others support you and your medical issues, they become healthier too?
Please respond to the questions below. Write on the back, if you need more space.
● In the past, what type of support did you get from friends and loved ones for your medical issues? How did this support make you feel?
● Would you like to have more support now? If so, what type of support do you need?
● How can you ask others to give it to you?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: Schwartz C, Meisenhelder JB, Ma Y, Reed G: Altruistic social interest behaviors are associated with better mental health. Psychosom Med 2003 Sep-Oct;65(5):778–785.
Did you know that … what you know, think and believe may help you feel better about your medical issues?
Please respond to the questions below. Write on the back, if you need more space.
● Why do you think you developed your current medical issue?
● Do you have a belief or view of the world that comforts you? How does this belief affect how you take care of your health?
● How can you use your belief to help you take better care of your health?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: Jantos M, Kiat H: Prayer as medicine: how much have we learned? Med J Aust 2007;186(10 Suppl):S51–S53.
Worksheet 3. Power of Positive Thinking
Did you know that … positive thinking can help you live longer, reduce depression, and overcome many stressful problems?
Please respond to the questions below. Write on the back, if you need more space.
● What do people admire most about you?
● What do you like best about yourself?
● How can you use these qualities to take better care of your health?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: Mayo Clinic: Positive thinking: reduce stress by eliminating negative self-talk, n.d. Available at http://www.mayoclinic.com/health/positive-thinking/SR00009. Accessed 12 July 2013.
Worksheet 4. Setting Personal Goals
Did you know that … you are more likely to become healthier when you set personal goals and take small steps to meet them?
Please respond to the questions below. Write on the back, if you need more space.
● What health goals would you like to achieve? Take one of your goals and break it into small steps.
● What might get in the way of reaching each of these steps?
● How can you overcome these possible problems?
● Set a deadline for each step and begin your plan!
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: Powers MA: Diabetes BASICS: education, innovation, revolution. Diabetes Spectr 19(2):90–98, 2006.
Did you know that … being thankful can help you become healthier?
Please respond to the questions below. Write on the back, if you need more space.
Many people find that their medical issues improve their lives in some way. They may take better care of their health, are more thankful, or even feel grateful for the things in their lives that are going well.
● What are you thankful for? How can you use these things to motivate you to take actions that help you stay healthy?
● What positive effect have your medical issues had on your life?
● How thankful are you for these changes?
● How have your medical issues positively affected the people around you?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: Tierney JA: Serving of gratitude may save the day. New York Times, page D1, 2011.
Worksheet 6. Dealing With Stress
Did you know that … listening to music can reduce your stress level?
Please respond to the questions below. Write on the back, if you need more space.
● Doing enjoyable activities can help you relax and improve your health. What types of activities do you enjoy?
● How can you make more time to do the things you enjoy?
● Who can help support your effort to find more time to relax?
● How can you ask them to help you?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: Mandel SE et al.: Effects of music therapy and music-assisted relaxation and imagery on health-related outcomes in diabetes education a feasibility study. Diabetes Educ 39(4):568–581, 2013.
Did you know that … the food choices you make can help you manage your diabetes and slow or even prevent many complications?
Please respond to the questions below. Write on the back, if you need more space.
● What healthy food choices do you make?
● How do you feel about making these choices? How can you choose healthy foods more often?
● How can you invite your loved ones to support your need to eat healthier? How can you help them eat healthier also?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: American Diabetes Association: Nutrition recommendations and interventions for diabetes. Diabetes Care 2008;31:S61–S78.
Did you know that … people who move more, manage their diabetes better, have less stress, and have a lower risk of heart problems?
Please respond to the questions below. Write on the back, if you need more space.
● Do you do any regular physical activity? What do you do? What part(s) of your workout do you enjoy?
● If you were active, but stopped, what motivated you to be active in the past? How can you use that to help you start moving again?
● If you are active now, how can you maintain or increase your activity level?
● How can you ask others to support your need to be more active (and, maybe help them become more active too)?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: American Association of Diabetes Educators: Diabetes and physical activity. Diabetes Educ 2012;38(1):129–132.
Worksheet 9. Monitoring Blood Glucose
Did you know that … checking your blood glucose level can help you manage your diabetes better?
Please respond to the questions below. Write on the back, if you need more space.
● How do you feel when you see your blood glucose result on your glucose monitor? How do you feel when the result is not what you expect it to be?
● How can you use these feelings (good or bad) to motivate you to take better care of your health?
● Some people view their glucose monitor as “hiker’s compass” that helps keep them on the right track. How do you view your monitor and why?
● How can you use your attitude toward your glucose monitor to help you take better care of your diabetes?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: Goldstein DE, et al.: Tests of glycemia in diabetes. Diabetes Care 27(7):1761–1773, 2004.
Worksheet 10. Feeling Overwhelmed or Frustrated
Did you know that … many people with diabetes feel overwhelmed and frustrated? Please respond to the questions below. Write on the back, if you need more space.
● Do you ever feel overwhelmed and frustrated with your diabetes? What do you think causes these feelings?
● You have control over how you respond. When you feel that way, what do you do to feel better?
● What type of support can help you feel more upbeat about living with diabetes?
● What steps can you take to get this support?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: Polonsky WH: Emotional and quality-of-life aspects of diabetes management. Curr Diab Rep 2(2):153–159, 2002.
Worksheet 11. Learning New Skills
Did you know that … you may need to learn some new skills to care for your diabetes?
Please respond to the questions below. Write on the back, if you need more space.
● Diabetes care requires many skills. Some may be easy to learn and some may be harder for you to master. What diabetes skills have you learned to do?
● How do you feel about yourself and all that you have learned?
● How can you use these feelings to motivate yourself to take even better care of your health?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: American Association of Diabetes Educators. AADE7™. Available at http://www.diabeteseducator.org/ProfessionalResources/AADE7. Accessed 22 May 2014.
Worksheet 12. Understanding the Positive Power of the Diabetes Police
Did you know that … people who nag you about your diabetes care often are called the “Diabetes Police”?
Please respond to the questions below. Write on the back, if you need more space.
● Do your friends or family ever bother you about your diabetes care? What type of comments do they make to you?
● What do you think motivates them to say these things? Put yourself in their shoes for a moment and consider their point of view. Does this change how you feel about them?
● How do you handle their comments? Do you ever think of their comments as signs that they care about you? Have you ever thanked them for the things they do that help you?
● What have you learned from what they say to you? How can you use their comments to motivate you?
What is one thing you learned from this worksheet that you can share with your health care provider?
Source: Roszler J, et al.: The Secrets of Living and Loving with Diabetes. Chicago, IL, Surrey Books, 2004.
These worksheets, hopefully, will encourage your patients to be more thoughtful about their lives and how their behaviors affect their health. After completing a worksheet, your patients may wish to ask you additional questions. As you answer their questions, be sure to acknowledge and praise your patients’ interest in caring for their health. If they seem interested, encourage them to suggest worksheet topics that can help them and other patients learn and grow. If they didn’t fill out the worksheet, that information is helpful, too. Try to learn and understand why they rejected the assignment.
Recognizing Progress
Our Diabetes Progress Scale is an outgrowth of the strength-based, proactive approach we are promoting throughout this book. We hope that this scale will help patients recognize and appreciate the progress and improvements they have made or hope to make. Living with diabetes or any chronic illness is difficult. Each day is filled with many challenges that many of our patients face with great skill and courage. These efforts deserve recognition. Present this scale in its entirety or choose specific items you wish to share, and give them to your patients while they sit in the waiting room.
The Diabetes Progress Scale
It is not easy to live with diabetes. Think about how far you have come since the day you learned you had diabetes. Read through the following list. Circle the number that shows how impressed you are with how well you do that item. Place a star next to the ones you would like to start doing so you can focus your efforts. Your number rating is not a grade, but rather it is a way for you to increase your awareness of the things you do well.
Scale: 1 = not at all; 2 = a little; 3 = somewhat; 4 = a lot
1. I’m impressed that … I take care of my diabetes and still want to do my job, enjoy my family and have fun. 1 2 3 4 (Find balance)
2. I’m impressed that … I try not to worry about future problems and focus on living well with diabetes day by day. 1 2 3 4 (Think positive!)
3. I’m impressed that … I ask questions if my health care team wants me to do something I don’t understand. 1 2 3 4 (Search for answers)
4. I’m impressed that … I see my blood glucose test results as “feedback,” not as negative judgment. 1 2 3 4 (I don’t have to be perfect!)
5. I’m impressed that … I know how to ask loved ones for help with some of my diabetes tasks, and do so, when I want it. 1 2 3 4 (Family support)
6. I’m impressed that … I try to follow my meal plan and notice triggers that cause me to make poor food choices. 1 2 3 4 (I’m aware)
7. I’m impressed that … When loved ones nag me about my diabetes, I thank them for caring and try to accept their messages in a positive way. 1 2 3 4 (Think positive!)
8. I’m impressed that … I plan ahead, so I can be more active (i.e., I put my sneakers in my car, I make workout plans with others, etc.). 1 2 3 4 (Create new habits)
9. I’m impressed that … I use all the members of my health care team (dentist, eye doctor, dietitian, nurse, psychologist, teachers, etc.) to help me stay healthy. 1 2 3 4 (I take care of my needs)
10. I’m impressed that … If my doctor seems displeased with my progress, I try to hear the care and concern beneath the comments that he or she makes. 1 2 3 4 (See the good in others)
11. I’m impressed that … When I feel like I’m not taking care of my diabetes well, I think of all the health tasks I do well and don’t allow my negative feelings to last long. 1 2 3 4 (Look on the bright side)
12. I’m impressed that … I don’t let diabetes limit my social life; when I feel good about myself, people respond to my positive attitude. 1 2 3 4 (I’m important)
13. I’m impressed that … When I worry about long-term complications, I remind myself that the better I take care of myself, the healthier I will be. 1 2 3 4 (Take care of myself)
14. I’m impressed that … I can ask my health care team to understand what it’s like for me to have diabetes. 1 2 3 4 (I accept myself)
15. I’m impressed that … When I feel overwhelmed, I check to see if I feel this way because my blood glucose is out of range or has been swinging high and low. 1 2 3 4 (I monitor myself)
16. I’m impressed that … When I feel overwhelmed, I ask my team to help me set smaller goals. 1 2 3 4 (Goal setting)
17. I’m impressed that … I can help loved ones learn how to support me by talking to them or by bringing them with me to my appointments. 1 2 3 4 (Build a support team)
18. I’m impressed that … What I do also helps educate my loved ones so they can become healthier. 1 2 3 4 (I’m a good role model!)
The Takeaway
Set the stage for growth before you meet with your patients.
