A practice nurse has ten minutes in which to walk a tightrope between managing a patient’s agenda and imparting lifestyle advice.
Health promotion is arguably like a trapeze which has swung so far in favour of lifestyle issues that we are at risk of alienating a sizeable proportion of the general public who believe the NHS is a safety net which will catch them regardless of how many cigarettes they smoke or how sedentary they are.
I have a friend who dedicates her time to her local community. She is a wonderful mother who is both capable and smart. Above all, she is kind, caring and hospitable. But the thought of making an appointment with her practice nurse or GP fills her with dread, because she just “knows” she would be “told off” about her weight and reduced to a quivering state of jelly (sugar- free), with tears (reduced salt), welling in her humiliated eyes. This is a prime example of a nurse-patient relationship that is already beyond repair even though it has not yet even taken place. I do not believe this is untypical.
So, when exactly did we become the health police? I’ve lost count of the initiatives, directives, consultation documents, white papers, green papers, assessments of local health needs created by a nanny state approach to healthcare. These days we’re expected to “nudge” people into adopting healthy lifestyles, which I suppose is a more genteel way of trying to get patients to bend to our will. And when nudging doesn’t work, as it almost certainly won’t, what happens then? Another consultation document to mull over?
Of course, there are many models and theories which underpin health promotion, and I suspect we all have our preferred frameworks on which to base our care. Perhaps the time has come to turn health promotion on its head, offer brief health information, but otherwise adopt a laissez–faire approach with the general public, and just see what happens. The result may prove surprising - with targeted planning by local authorities and voluntary groups, people may become responsible for their own well-being.
One thing is for certain - I have never met anyone yet who looks even mildly surprised when they are told that cigarette smoking can be harmful, but we persist in repeating this message in a scary/ yucky/ heart rending /humorous/ colourful/ funereal (delete where applicable ) way. Whenever patients come to see me about lifestyle change they are often expecting to fail. I can work with that, and so can many other practice nurses who are adept at utilising patient-centred health promotional techniques.
The days of believing that a “good” patient is one who engages in lifestyle change needs to be numbered. However, if a patient presents with tonsillitis, ingrowing toenails or blocked ears, should nurses really be expected to encroach into their ten minutes of appointment time to reach for the scales, ask about units of alcohol consumed weekly, or wrap a tape measure between his lower ribs and iliac crest?
Jane Warner is locum practice nurse in Somerset; and associate lecturer, General Practice Nursing Foundation Programme, University of Plymouth