THE CURIOUS ENQUIRER. Getting the client s committed yes To doing exercise. Margaret Daly Occupational Therapist RNSH

Transcription

1 THE CURIOUS ENQUIRER Getting the client s committed yes To doing exercise Margaret Daly Occupational Therapist RNSH mjdaly@nsccahs.health.gov.nsw.au margdaly@mac.com

2 Client Engagement in Regular Exercise Some are compliant & just do it What about the others????

3 The Usual Health Professional Way Prescribing Telling Instructing Informing Demonstrating/showing Fixing Quoting the evidence Arguing the evidence Warning of risks

4 The way of the Curious Enquirer Looks for the RIGHT QUESTION (Rather than giving the right answer) Becomes the Motivational Interviewer

5 Motivational Interviewing Four Guiding Principles (Rollnick S, Miller W, Butler C, (2008)Motivational Interviewing In Health Care, New York, Guilford Press, Ch.1, pp7-10, ) Resist the righting reflex Understand your (client s) motivations -probes to find what motivates the person Listen to your (client) Empower your (client)

6 The Curious Enquirer.. Resists the righting reflex!!!! Puts aside Making it right Prescribing Telling Quoting evidence Warning re risks etc. This is harder than it sounds!!

7 The Curious Enquirer. Understands their client s Motivations -probes to find the client s motivation for change What are the client s interests and concerns What does your client want to be able to do? What are your client s perceptions?

8 Sample questions If you felt really confident in your walking, what additional things would you be doing? What do you think will happen if you can t walk well? What do you think will happen if you find that you can move less and less? What will be the practical outcome of that? Is that what you want? How can you avoid that do you think? What would like to be able to keep doing? Have you given up on anything because of decreased/limited mobility? Do you notice other people about your age who you think are moving really well? What are your thoughts about that?

9 The Curious Enquirer Listens to their client Empathic listening At least as much listening as talking Intuiting meaning

10 Possible phrases So you feel It sounds like I m wondering if.. What I m hearing is. So your thinking here is. So your perception of this is.

11 The Curious Enquirer Empowers their client.. Outcomes are better when clients take and active interest in their own health care rather than being passive recipients Help your clients explore how they can make a difference in their own health take responsibility, take control The client s own ideas and resources are key here Let your client consult to you on their life

12 Possible Questions What gets in the way of exercise? How would you feel about exercise if we gave it a different name? e.g. Keeping moving to stay independent? Where might you fit some exercise into your day? e.g. Could you park further away at the shops so that you have to walk a little further? Are you better in the mornings or the afternoons? How could you have it be fun? Is there someone who might be your exercise buddy? How could you reward yourself?

13 What you are Looking for.. Your client s Ah-ha moment That they gain insight into themselves That they gain insight into the cascade effect of not keeping active and mobile around things that are important to THEM A leverage point

14 Ask Permission. Would you like some information about.? Would you like me to demonstrate.? Would you be interested to know a bit more about.? Are you interested in what the science says about that? I can give you more information about that if you are interested.

15 Different Approaches/Angles - No.1 Use different language Moving about Activity Being active and independent Vigorous movement Working up a sweat Getting your heart rate up Building fitness Building strength Building stamina

16 No.2 Find a time fit Where would this fit best in your day? Would it help if we broke it up into 3 short bursts rather than one long one? Where could you fit 3 short bursts into your day? Are you a morning person or would exercise fit better into your afternoons?

17 No.3 Make it fun What would make it more enjoyable for you? How could you make this more enjoyable? Do you notice other people enjoying exercise? What do you think makes it enjoyable for them? What might make it enjoyable for you? Would it be possible to have some fun doing this?

18 No. 4 Integrate it into daily activities Could you do your squats when you are at the sink? Could you sideways walk to the door? How about doing 3 sit to stands in the TV add breaks during your favourite program? Could you park further away at the shops so that you walk a bit further?

19 No. 5 Establish a visible prompt Do you ever make a visible reminder prompt for yourself for anything? Could we do that for your exercises do you think? What about putting a reminder post it on the front door/mirror/fridge? If you put your weights beside your TV chair do you think you would be prompted to do it?

20 No. 6 Create some accountability Who might help you stay on track? Who might help you get it done? How could you set that up? Who would you choose to check that you are doing it? What about having an exercise buddy? Who could that be?

21 No.7 Use a hypothetical What might it take for you to make a decision? If you did make a change what might be some of the benefits? Suppose that you did decide to How would you go about it in order to succeed? Lets imagine for moment that you did How would your life be different?

22 No. 8 Get your client to self measure How important out of 10 is that? How satisfied out of 10 are you with that? What would you give yourself out of 10 for Your walking Your balance Your stamina Your co-ordination Your confidence in your mobility Moving about at home? Moving about outside? Moving about in the community?

23 Responses to self measures.. If your client gives themselves a 2/10 RESPONSE As much as that! Good, you re on the scoreboard. What gets it to 2 for you? Are you happy with that or would you like to get it higher? What would you like to get it to? What do you think you might have to do to get it to that? Would you like me to help you get it to that?

24 No. 9 Build in a reward Do you ever reward yourself for getting things done? Could you reward yourself for getting it done? What would be a good reward for getting your exercise done? What s something you like to do everyday? How about making that your reward for getting your exercise done?

25 Follow Up Reinforce achievements and gains Well done you! How does it feel to have achieved that? What will you do next?/what s next for you? Explore blockages/not getting it done What happened about your exercise plan? Did you get it done? What got in the way? What do you think needs to change? How could you do it differently so that you get it done?

26 Closing comments Ask HOW, WHAT, WHERE, WHEN, WHO. These invite reflection Avoid WHY - it invites defensiveness A why-ish question try what s that about? Ask the right questions so that your client can work out what works for them. Your client will be much more committed to their ideas than yours!

27 References References: Rollnick S, Miller W, Butler C, (2008) Motivational Interviewing in Health Care: helping patients change behaviour, New York, Guilford Press. Grant A, & Greene J, (2004) Coach Yourself: make real changes in your life, Suffolk, Momentum. Grant A, & Greene J, (2005) Coach Work, Sydney, ABC Books. Bolton R, (2005) People Skills: how to assert yourself, listen to others, and resolve conflicts, Pymble, Simon and Schuster. Egan G, (1986) The Skilled Helper, Belmont California, Brooks/Cole.

28 Thank You