Linda Davis, RN-BC, firmly believes nurses must practice what they preach. "I honestly can't imagine counseling patients about something I don't believe in or practice in my own life," said Davis, a cardiac rehabilitation supervisor at Washington Adventist Hospital, Takoma Park, MD. "One way we learn is by observing healthy behaviors in others, and that's part of the job description in cardiac rehab. If you're terribly overweight, it's hard to imagine how you can counsel your patients effectively about weight management. I can imagine them thinking, 'Why can't she lose weight if she thinks it's so important?'"
Cardiac rehab nurses must be believable to be effective. "Our patients often ask, 'What do you do?' or 'How do you handle this situation?' and it's important to speak from experience and give examples from your own life," Davis explained. "That type of interaction gives you credibility with patients and engages them in the change process with a positive attitude."
Davis smoked in her teen and young adult years before an acquaintance challenged the habit. "I was in nursing school and a bunch of us were standing around smoking," she recalled. "When a friend asked me, 'Why are you doing this?' I realized I needed to quit. I can understand the effort it takes to make behavioral changes and maintain a healthy lifestyle, so I have empathy for our patients who face similar challenges."
A Different Way of Living
Nancy Moore, RN, CET, a staff nurse and coordinator of EECP [enhanced external counterpulsation] at Shady Grove Adventist Hospital's Cardiac Rehab Center, Rockville, MD, recalled how her rehab role increased her awareness about physical activity and health.
"When I was working as a staff nurse on the cardiac floor of the hospital, I felt I exercised enough just by running around all day," she explained. "When I came to cardiac rehab, I lost 25 pounds in my first year, as I became aware of the need to exercise regularly and eat healthy. Today, whenever patients say, 'It's hard for me to schedule the time to exercise,' I can say that I've faced a similar situation."
Moore understands how easy it is for women to put themselves last. "Physical fitness is not a diet, it's not an exercise program; it's a different way of living!" she emphasized. "I tell my patients we need to schedule the time for regular exercise and make it an important part of our day. I can tell them how I lost 25 pounds by getting up at 5 a.m. to come in and exercise before work, and how I've kept that weight off for the past 6 years."
A Healthy Dose of Realism
Kristin Duquaine, MHA, MSN, RN, CDE, director of community health and wellness at Florida Hospital for Children, Orlando, started her learning journey after she was diagnosed with type 1 diabetes when she was 13 years old.
"I understand the degree of commitment and amount of effort it takes to establish and maintain good habits over the years," she said. "When you are truly managing your diabetes, you're constantly aware of the food you put in your mouth, the amount of sleep you get, your physical activity throughout the day and stress levels that affect your blood glucose. Because I know exactly where the challenges are and where people get hung up, I can provide effective coaching and teaching."
Duquaine shared some practical advice for nursing colleagues. "You have to have a healthy dose of realism when you talk with patients about chronic disease and lifestyle management," she said. "They can get tired of healthcare professionals who preach to them with a constant list of rules. Instead, frame the dialogue with real-life scenarios and applications as much as possible. Identify sequential steps for change and then encourage them to take one step at a time."
Acknowledge that mistakes will happen and no one is perfect, said Duquaine. "The all-or-nothing theory is just not true when it comes to diabetes management," she said. "Any effort we make toward positive changes is a good thing. Get away from labels like 'bad' versus 'good,' and be very real when you discuss lifestyle choices. When I'm talking with patients and their parents, I bring up mistakes I made growing up. It's a great educational message: here's a diabetes educator who wasn't perfect; so if I make a mistake, I can still move forward toward a better lifestyle."
The Journey Back to You
Cathy C. Akers, MSN, RN, bariatric coordinator at the Bariatric Care Center of Providence Hospital, Washington, DC, learned an important lesson when she had bariatric surgery 5 years ago. "Weight loss is a journey back to you," she explained. "It's an opportunity to revisit the best person you can possibly be. I'm 50 years old and can appreciate how people can look at their lives in a new and extraordinary way."
Akers shares a pragmatic perspective based on the lifestyle changes she made and sustained to manage her weight. "It's all about redefining your relationship with yourself and understanding this is a behavior change that takes place over time and not overnight," she said. "People who aren't willing to enter into conversations about weightloss typically have put their husbands, kids, parents, jobs and other responsibilities ahead of themselves. They've put their own health on the back burner for so long, and it can be very difficult to help them understand they have to put themselves first some of the time. We give them permission to be a little more selfish and self-focused.
"I'm not interested in weightloss for cosmetic purposes, helping people find their inner Beyonce," Akers emphasized. "I'm committed to helping people own and accept healthy changes in their lifestyles from this point forward. A goal is not a destination on a scale - if I reach 110 pounds, what do I do when I get there? The goals we support are behavioral ones that they can maintain over time. I want them to be able to walk past that long table of doughnuts and pastries, pick an apple from the bowl and enjoy it because it makes them feel good."
When she counsels bariatric patients, Akers helps them establish realistic expectations. "You never forget how good a doughnut tastes, but you do feel good about choosing that apple," she noted. "We replace unhealthy behaviors with ones that produce a good energy. What are you going to do for yourself each day, instead of to yourself each day?"
Sandy Keefe is a frequent contributor to ADVANCE.