Section 1.
Lifestyle Modifications
Child Health Checks
- Alcohol, tobacco and other drugs (child)
- Birth information
- Birth mother’s history
- Body measurements (child)
- Clinical measurements (child)
- Continence and elimination (child)
- Developmental milestones
- Ears and hearing (child)
- Environment 101 Eyes and vision (child)
- General appearance
- Infant reflexes
- Nutrition (child)
- Oral health (child)
- Physical activity (child)
- Social-emotional well-being (child)
- Skin (child)
- Special considerations
Engaging our patients
Background1,2,3
-
- Productive health outcomes are achieved by involving patients in treatmentdecisions and management of their condition
- Helping patients can be difficult and confusing
- Despite good intentions, clinicians tend to be reactive to patient health issues without informed knowledge of the significant personal, social, emotional and financial implications effecting their lives
- Skilled communication takes time to learn and practice to be effective
An evidenced approach1,2,3
- Clinicians should use evidenced behaviour change intervention skills (See Resource 1.) with origins in health psychology, applied to varying contexts
- Clinicians should continue to develop and practice effective communication skills to help patients modify their health behaviours
1. What is effective communication? 1,2,3
- Core skills and processes to successfully help others
- A way to work with and support individuals to help them achieve their goals within their broader socio-economic and cultural environment
- A way to equip clinicians to respond to the needs of individuals and families
2. Clinician qualities 2,3,4,5,6
- The personal qualities that clinicians (as helpers) bring to a relationship (or partnership) with a family or patient include:
- being respectful by accepting and valuing patient decisions and views
- being genuine, sincere, reliable and honest without judgement or defensiveness
- having humility by understanding our own limitations and being flexible to accept and learn that patients know what is best for themselves
- being empathic, by seeing, understanding, experiencing and feeling the world from our patient’s points of view and setting aside our own biases, views and anxieties
- being enthusiastic, warm, and encouraging and maintaining a positive outlook
- having personal integrity, by having the maturity to listen and accept the feelings, ideas and views of our patients
- being constructive and sensitive when making judgements and to recognise the impact of our own feelings and views on the process of help using knowledge, experience and technical expertise
3. Clinician skills 2,3,5,6
- These are the observable behaviours and communication methods clinicians use to interact with families and individuals
- They enable clinicians to most effectively express the Helper qualities with patients
- Helper skills include:
- listening closely. Being attentive without distraction
- communicating clearly and summarising accurately
- showing empathy and being receptive to the patient’s life experiences
- actively negotiating, seeking, clarifying and exchanging ideas and priorities with patients
- being encouraging and build patient confidence by admiring and praising their efforts
- being focused and prioritising
- helping patients to change ideas, feelings and behaviours
"The most basic of all human needs is the need to understand and be understood. The best way to understand people is to listen to them"
- Ralph Nichols (1910 - 2001)
4. Characteristics of our patients and families 2,3,5,6
- Patients and families engage with health services for many reasons. Our ability to help them will depend on our ability to form an effective partnership
- Patient and family characteristics can include:
- cultural diversity, rights, views, values and expectations of Indigenous Queenslanders – nature of problem(s)
- barriers to engagement
- motivation to change
- attitudes and beliefs about services
- expectations of outcome
- socioeconomic circumstances
- key needs and strengths
5. Characteristics of our service 1,2,3,7,8
- Forming partnerships with our patients is:
- a key Queensland Health investment strategy action towards closing the gap in health outcomes for Aboriginal and Torres Strait Islander Queenslanders by 2033 by “embedding cultural capability in the planning, design and delivery of health services by enhancing the knowledge, skills and behaviours of the health workforce in culturally responsive patient care”
- a Queensland Health service strategy to “engage consumers and communities about their health, and promote and influence healthier choices and protective behaviours”
- The key characteristics of our service and our communities are:
- diversity of cultures
- reflective practice, supervision and support
- skilled, knowledgeable and competent staff
- drive and enthusiasm of practitioners, managers etc.
- attitudes and beliefs about service provision
- expectations of change and outcome
- organisational culture, structure, stability, openness and flexibility, value of and access to meet user needs
- resources available and their use
6. Constructs 2,3
- People are shaped by many factors throughout their lives including their culture, community, family, friends and parents
- As we become older these factors shape the way we view, make sense of, and react to our day to day experiences; our constructs
- Constructs are:
- thoughts and feelings attached to our actions and behaviours
- continuously shaped and influenced by subsequent experiences throughout our lives – functional, helping us to feel safe and secure in the world
Patient constructs influence their willingness and ability to engage and respond to the help available.
Clinician constructs affect perceptions of patient strengths and difficulties Helping patients sometimes involves 'loosening' or challenging unhelpful constructs
7. Collaboration 1,2,3,5,6
- The partnership (or relationship) requires the clinician and patient to:
- communicate openly and clearly
- engage constructively in the helping process
- develop and maintain genuine connectedness
- recognise complementary expertise and roles
- share decisions
- trust and respect one another
- be supportive, open, honest, influential, connected and purposeful
- A partnership is not an expert, dependent, friendship, adversarial or avoidant relationship
Do no harm; while we may not always be able to 'make things better', we certainly shouldn't make them worse!
8. Helping 1,2,3,4,6
- The process of helping includes:
- exploring the situation(s) to get a clear picture
- a shared understanding of the patient’s strengths and needs resulting in an agreed set of priorities for change
- setting SMART goals to ensure clear outcomes
- clear and realistic strategies are planned to ensure goals
- clinicians supporting patients to implement plans with sufficient skills, expertise, enthusiasm and confidence
- Reviewing outcomes and exploring the nature/usefulness of the partnership and, if necessary, altering it to ensure progress
- ending the partnership, with clear future strategies to ensure sustainability, onceoutcomes have been reached and supports are in place
- These tasks:
- are undertaken in partnership
- enable clinicians and patients to explore and develop a shared understanding of the patient’s ecology
- lead to negotiation of goals and a plan that is supported and reviewed over an agreed period of time
9. Change 1,2,4
- In partnership, clinicians and patients work together to achieve meaningful change and outcomes
- Three related processes that underpin change are:
- spontaneous change: occurs through the process of exploration and understanding, as patients’ capacity for change is stimulated by feeling heard by clinicians
- guided change: occurs through the loosening of unhelpful constructs and the strengthening of constructs more likely to help patients achieve their goals and outcomes
- planned change: occurs through the systematic use of goal setting, planning and implementation to bring about specific change
- There will be times when safety is at risk and change has to happen. It is important to work hard to navigate such situations respectfully, openly and in partnership
10. Outcomes 1,2,3
- Effective behaviour modification aims to provide patients with the ability to:
- develop strengths and abilities to be more effective in helping themselves
- identify, clarify and manage their problems
- change knowledge, feelings and understanding of themselves and their situation
- view and experience themselves in accurate, helpful and constructive ways
- develop involved and consistent personal skills
- develop effective social support and community involvement – foster resilience by predicting potential future problems
- The outcomes for clinicians are to:
- do no harm
- encourage and maintain patient engagement and participation
- help patients to achieve change and improve outcomes
- implement effective, mutually agreed actions that address patient difficulties
- improve the quality and effectiveness of service delivery
Engaging our patients isn't always about 'making things better'. Sometimes things can't change in the way we'd like. In this case it's about making the best of a situation while maintaining a respectful partnership despite actions that need to be taken i.e. patient beliefs or behaviours that impinge on safety
11. Where to from here?
- A first step is to develop and practice the skills and knowledge to communicate with our patients
- Understand the patients and population your service targets. For those in rural and remote areas of Australia this would include undertaking a cultural awareness program tailored to your population
- Although speaking with patients can be easy, speaking with patients in a meaningful, constructive manner to effect behavioural change can be difficult
- The skills and ability to purposefully engage patients to make positive changes takes time, experience and training
- Engage your local health service for communication, engagement and counselling training
12. References
- Vallis M, Lee-Baggley D, Sampalli T, Ryer A, Ryan-Carson S, Kumanan K, Edwards L. Equipping providers with principles, knowledge and skills to successfully integrate behaviour change counselling into practice: a primary healthcare framework. Public Health; 2018; 154. pp 70-78. Accessed: 2019, July. Available from: https://www. clinicalkey.com.au/#!/content/1-s2.0-S0033350617303578
- Davis H, Day C. 2010. Working In Partnership: The Family Partnership Model. London: Pearson Assessment. Accessed: 2018, May. Available from: https://www.pearsonclinical.com.au/products/view/163
- Day C, Ellis M, Harris L. 2015. The Family Partnership Model: Reflective Practice Handbook. London: Centre for Parent and Child Support. Accessed: 2018, May. Available from: http://www.cpcs.org.uk/index.php?page=about- family-partnership-model
- Notaras S, Mak M, Wilson N. Advancing practice in dietitians’ communication and nutrition counselling skills: a workplace education program. 2018; 31 (6). pp 725-733. Accessed: 2019, July. Available from: https:// onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12569
- Rautalinko E. Reflective listening and open-ended questions in counselling: Preferences moderated by social skills and cognitive ability. Counselling & Psychotherapy Research; 2013; 13 (1). pp 24-31. Accessed Available from: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=ccm&AN=104240680&s ite=eds-live
- Brand T. Basic counselling skills. South African Medical Journal; Vol 104, No 7 (2014); 2014. Accessed: 2019, July. Available from: http://www.samj.org.za/index.php/samj/article/view/8434/6037
- Queensland Health. 2017. Department of Health Strategic Plan 2016-2020 (2017 Update). State of Queensland (Queensland Health). Accessed: 2018, May. Available from: https://www.health.qld.gov.au/system-governance/ strategic-direction/plans/doh-plan
- Queensland Health. 2015. Making Tracks towards closing the gap in health outcomes for Indigenous Queenslanders by 2033: investment strategy 2015–2018. State of Queensland (Queensland Health). Accessed: 2019, Jan. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0020/161831/making-tracks- inv-strat.pdf
