Setting health behaviour change goals with Sandy

You might like to review the information on health behaviour change available at the Cardiac Rehabilition module before looking at this section.

Sandy and the Heart Failure Nurse meet to discuss potential health behaviour changes that Sandy could make in order to reduce his cardiovascular, pulmonary and diabetic symptoms. They structure their discussion around an Agenda Chart and a Readiness Ruler. The three main questions to be addressed by Sandy are:

What would you like to change (if anything)?
How do you think you could do this?
What support do you think you might need in order to do this?

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Setting Health Behaviour Change Goals with Sandy

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HF NURSE: Let’s have a look at the chart, Sandy. Hopefully, you’ll understand what we’re doing, now that I’ve explained it to you. Are there any areas on the chart where you feel you might benefit from a change in your behaviour?

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SANDY: I think there are probably quite a few areas that I could change my behaviour in! My main area of concern is my alcohol intake. And I know that I smoke far too much. I do a fair bit of running about at my job and tend to walk a lot because I don’t have a car. My diet isn’t great – too much pub grub and takeaways. Now that we’ve sorted out my pills, I think I’ll be much better at taking them when I should.

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HF NURSE: Okay, let’s look at some of these areas in a bit more depth. Why don’t we concentrate on your drinking and smoking, to begin with, and we can look at diet and exercise the next time we meet. Let’s start with your alcohol intake. How much alcohol do you think you drink during the course of the day?

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SANDY: I’m normally okay until I go to work. You know what it’s like in the pub – people offer me drinks and I don’t like to refuse, so I probably have four or five pints during a shift. If I come in to the pub for something to eat before I start work, then I’ll normally have a couple of drinks with my food. I quite like to have a wee dram or two once I get home, too, to help me relax before bed.

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HF NURSE: That’s quite a lot of alcohol, Sandy. It’s certainly well over the recommended limit. Is that every day or do you not drink on your days off?

SANDY: I usually go to the pub on my days off, just to meet my mates and get a bit of company. I get bored in the house on my own, If anything, I probably have more to drink on those days, rather than less.

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HF NURSE: Have you tried cutting down on alcohol before?

SANDY: Yes, plenty of times. But I always seem to fall off the wagon.

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HF NURSE: Would you consider going to the Alcohol Addiction service for support? I realise that they’re based a wee bit away but your Cash in Your Pocket scheme might be able to help out.

SANDY: I could give it a go, I suppose. It’s not something that I’ve thought about before. I know that I’m going to have to do something about my drinking or I’m going to end up killing myself – if not from my heart, from liver disease!

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SANDY’S READINESS RULER:

READINESS – 9
CONFIDENCE – 5

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HF NURSE: So, what about your smoking, Sandy. How many cigarettes do you think you smoke a day?

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SANDY: I try to limit it to 20 a day. Now that we can no longer smoke in the pub, I’ve cut down quite a bit. I tend to smoke more when I’m drinking so, if I could drink less, maybe I’ll smoke less, too.

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HF NURSE: Have you ever tried to stop before?

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SANDY: Yes, every New Year’s Day! But I never last long. I’ve tried nicotine patches and gum and all sorts but none of it worked. I was wondering about trying those vapour cigarettes but I’ve never got round to it.

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HF NURSE: What would you feel about maybe going along to our Smoking Cessation sessions? Lots of people find them very beneficial. They’re on a Thursday afternoon at the Health Centre.

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