This is an example of a 40 year old man who has been diabetic for five years, who is a smoker with a family history of heart disease. His father died at the age of 50 of a heart attack. He is being seen for routine review. His blood sugar level is high and has been high every time he has come in. You have identified a need for intervention. 1. Get his story. What does he know, worry about? How does he think and feel about his diabetes? You might ask:
2. Share information you have - your version of how he is going.
3. Discuss what can be done. This process is about exploring options and choices, not about telling people what to do. He needs to make decisions for himself about what is possible, what he wants to do and how he may do it. What do you think you'd like to do? If he does not want to do anything, that is his choice. Record it. You may offer further information and let him know you are ready to help if and when he would like it. Identifying the barriers to change, as well as the good things about changing, can help find the solutions. If he wants to do something, you might offer some options of what could be done. It might stop there until next time, or you might define some goals together, offer support, and arrange another appointment. At this stage you may or may not deal with specifics such as smoking, but you need to ask and reinforce previous messages. Offer help if he wants to quit. If he has done something, build on the positive changes with questions such as "Was it hard?", "How did you do it?", "How does that feel?" Give a little information each time, keeping pace with the client. Do not be afraid of silences and fill in the gaps with information (it could be too much and misplaced. It may alienate him). This process often includes other family members. Involving others, and encouraging discussion can help to translate, clarify and reinforce the information shared. It can support the person to define manageable goals and make changes. Conclusion The brief intervention process, used in a series of consultations and tailored to the client, helps to build trust and may be very effective in the long term. The process brings together his story and your statistics and information. His story is just as important, if not more than your statistics. Together they are powerful. It enables him to make connections between what he is thinking and knows about diabetes, and his feelings about how he is living, his family and other things that are important to him. After making these connections between head and heart, he may be in a position to explore concerns and move towards a decision to make some changes. You can help to facilitate this decision making. Based on a case study by Tarun Weeramanthri, |
This is an example of how a health worker can connect a health problem with a drinking problem. The people talking are 'Ronald' an Aboriginal man, and an Aboriginal Health Worker.
So - Ronald came back a few days later and his leg was getting better. He said he hadn't had a drink and I knew there wasn't any grog around anyway. We didn't talk much more about his drinking but he did feel a bit better after a few days without it. I gave him a booklet about drinking to take and look at later. I also said he could come and talk to me any time. So at least maybe he's thinking about it. Information provided by NT Living With Alcohol
Program, |