Coaching for change

A pilot program in Queensland has enabled practice nurses to provide lifestyle advice to their patients in addition to providing general medical care, writes Jeff Li.

Practice nurses in three Queensland clinics are motivating their patients to change their lives for the better. And the results have shown nurses make great coaches.

With the aim of supporting an extended role for nurses in general practice, the Far North Queensland Rural Division of General Practice initiated a program where nurses were trained in brief lifestyle interventions.

Carole Forrester, project coordinator, says it was important that the programs, which ran over three to four months, were convenient for the patients involved.

By making it convenient, Forrester says rather than getting dietary products that may not necessarily be reputable from chemists, the program allows patients to get reputable advice from reputable. "Nurses can build on the existing relationship and use that to assist in health coaching," she says.

Clinics also had the flexibility to develop a program according to the needs of the demographics the practice serves.

Liz Paton from Kuranda Medical Service was involved in the program when it ran in her clinic from March to June last year. She told Nursing Review that it gives an outline to patients on how to achieve the goals. It also changes negative attitudes among patients.

During the program, she had a mix of indigenous and non-indigenous patients, so her clinic developed a program allowing patients to attend sessions either in person or over the telephone.

The three participating clinics nominated specific areas that they would be providing lifestyle coaching for. Forrester says the most important aspect of the program is that patients have to take the initiative to seek help from clinics.

In one case, a patient successfully changed her lifestyle through the program. Motivated by her pregnancy, she has successfully quitted smoking marijuana and switched her diet from food heavy in carbohydrates such as pies and pastries to fresh produce.

Forrester says it will be good to integrate courses in lifestyle coaching into nursing courses.

"As we are moving towards a preventative approach to health and primary health care, I think it'll be invaluable that nurses got this sort of training in their degree courses and their undergraduate training so that they are well-equipped at the time they go into nursing to be able to do lifestyle coaching."

Forrester also says that helping practice nurses form a networking group will be valuable to support each other and to maintain their skills. It will be an ongoing training scenario.

Paton says that this program provides basic health education, especially to the indigenous community and that it will cut down health cost significantly because it will avert unhealthy habits from early on.

However, at present, it is impractical for her to carry on with the program because of other responsibilities she has in the practice. To keep the program going, more support in terms of staffing level and training will be needed.

Forrest told NR that it cost $27,000 to implement the pilot program and that it achieved great results. But without further funding, she is not able to extend the program beyond the trial.

In order to continue with the program, she says that it should be put under Medicare coverage so that nurses will be remunerated for the hours of consultation they have done.

"If you are talking about trying to implement it with every practice, I think you have got to be looking at getting some sort of Medicare item number for lifestyle coaching, or some sort of payback to the practice to encourage them to use lifestyle coaching," she says.

The program is different from other similar lifestyle changes program, such as Lifestyle Modification Program by Brisbane South Division, in terms of both eligibility and method.

"They're [Lifestyle Modification Program] very narrow in terms of who is eligible to register for them and is very prescriptive sort of course and it has got to be a group education whereas mine, or the project, was a one-on-one coaching. There were some group sessions, but I think the one-on-one coaching works very well for patients," Forrester says.

Presenting a report on the pilot program to the report to the Australian Practice Nurse Association National Conference next month, she tells NR that by doing so, practice nurses will know that learning lifestyle coaching is something they can extend their skills with, particularly to nurses that are open to new challenges and developing new skills.

"This is certainly an innovative idea for a practice, and practices are going to be involved in preventive health rather than seeing all the side-effects of obesity, high blood pressure and diabetes and things and try to prevent it.

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