Hypertension: Non-pharmacological Treatment and Patient Education (Nursing)

00:01 So let's get back to helping your patient know what to do when we talk about lifestyle modifications.

00:06 We want them to minimize the modifiable risk factors.

00:10 So diet and exercise, considered diuretic therapy, and some antihypertensive medications.

00:18 First line, when you're thinking overall just giving you a snapshot.

00:21 If we're going to treat high blood pressure, lifestyle modifications, diet and exercise.

00:27 Diuretic therapy is usually our first line therapy trying to pull extra volume off, and then we have straight up antihypertensive medications.

00:36 That's kind of a four point plan for treatment.

00:40 So let's say we start with lifestyle modifications.

00:42 We asked them to minimize their modifiable risk factors.

00:45 Really tough for patients.

00:47 So then we try the diet and exercise we try the diuretic therapy, as a first line that may or may not be effective.

00:54 Then we'll go to antihypertensive medications.

00:57 Now some patients come in with such significant hypertension by the time they seek treatment that we may just jump right to, we're going to do all four of these.

01:06 But I wanted you to have a feel that we try to handle it with lifestyle modification, and diet and exercise first.

01:12 If that doesn't work, we may try a mild diuretic.

01:15 And then we may need to add antihypertensives.

01:17 But some patients get the whole package on the first visit.

01:23 Let's talk about how you help the patients change.

01:26 Now, this is my favorite. I know, I'm a nerd.

01:30 But this is my favorite model of change.

01:33 Prochaska and DeClemente came up with this model and here's the deal.

01:37 We're going to present it to you in kind of a set step, but it doesn't work that way.

01:42 See, when you're really trying to change something hard in your life.

01:47 It's not going to go like "Oh, I decided to change this today and tomorrow.

01:51 I've fixed it." It's messy.

01:53 It's not this to this. It's usually this to this...

01:57 So even though our model is very neat, and succinct, and precise.

02:03 That's not how change works.

02:05 We just wanted to show you, if some superhuman work through the stages, this is how it will look like.

02:11 "So, I'm going to have a conversation with a patient, I have to figure out what stage they're in right now, before I know how to help them move to the next level." That's it.

02:23 That's what our goal is.

02:24 So first of all, let's look at the stages: Pre-contemplation.

02:28 This patient has no intention of changing their behavior.

02:31 That's why we call it pre-contemplation.

02:34 It's before they're even thinking about it.

02:37 They are not in in any way.

02:40 Next, contemplation. Got rid of the pre.

02:44 Okay, now we're aware there's a problem that exists, but we don't really have any commitment to action.

02:48 So pre-contemplation.

02:50 "I didn't want to talk to you about this." Contemplation.

02:54 "Yeah, I know I should." But not really planning on how to do that.

03:01 Preparation.

03:02 "Oh no, I got it. I've thought about it.

03:04 I know I need to do this.

03:05 Now I'm starting to figure out, how can I do that in my life? What can I do?" Action.

03:11 "I'm actually doing something, right.

03:13 Taking active modification of my behavior.

03:16 I'm doing stuff." Maintenance.

03:18 "Now I've made the change. Now I just sustain it over time." Wouldn't it be awesome if we could all just do that 1,2,3,4,5 and be done? Yeah, well, that's not really a very difficult change.

03:31 A lot of us have relapses, right? You fall back into old patterns of behavior.

03:35 And you have to go through this all over again.

03:38 Let's use dieting as an example.

03:40 All right, that's a pretty common one.

03:42 And a lot of people struggle with it, but it applies to anything.

03:45 Drinking too much, tobacco, not exercising, all those things false, all those.

03:50 So let's say pre-contemplation.

03:52 The patient, they're overweight.

03:53 You approach them about changing their diet.

03:57 And they're like, "Yeah, they want to talk to you about this? Just give me your papers and get out of way." Next phase, the next visit, they come back.

04:03 They're looking at, "Ah, yeah, I know I should change my diet, but they don't really do anything about it." Next visit, they'll say, "You know, I've really been thinking about that.

04:15 And I've looked at some different options.

04:17 And I think I'm ready to talk to a dietitian.

04:20 And really get some advice and some help on how to do this." Next step.

04:25 All right, now I'm meal prepping, and watching what I eat, and making healthier choices.

04:30 Then I lose the weight and in maintenance, I just continue those healthy behaviors.

04:35 And I keep the weight off." Relapse.

04:38 Something bad happens.

04:39 I've been to emotional eating again, that's a relapse.

04:42 How long I let that relapse goes on.

04:44 Depends on where I end up on that cycle of change.

04:47 The most important thing is encourage the patient that this is normal.

04:53 Recognize where they are.

04:55 If I know someone's in pre-contemplation, I'm going to have a very casual conversation with them.

05:00 My emphasis is going to be on.

05:02 I understand how difficult this is.

05:05 But I just wanted you to think about some things.

05:08 You statements like we talked about earlier in the video.

05:10 Don't just say, "Being overweight is bad for hypertension." You want to let the patient know, "Hey, just some things to think about.

05:17 I know that you're aware, but I wanted to explain to you how losing weight will really help lower your blood pressure.

05:24 You'll have less volume onboard, your heart won't have to work as hard." That's where I have the pre-contemplation conversations.

05:31 Saying, "Hey, listen, no judgement here because we all have our challenges." Sit down and empathize with the patient.

05:38 Let them know that you understand changes hard.

05:42 If you're open to it, you can briefly and professionally share something that was difficult for you and how you're still working on it.

05:51 That will make a bond of trust with them.

05:53 As they're thinking about it.

05:55 You just help them make the next step.

05:56 Next step. Next step, next step.

05:58 That's how you use cycle of change.

06:01 I often show patients a picture of this model.

06:04 So they understand this is normal.

06:07 And you can ask them, "Where do you think you are?" We're talking about changing your diet today.

06:12 What phase do you think they are? They'll tell you.

06:15 Most patients, when you ask them a question like that, we'll give you an honest answer.

06:21 So we put this spiral in here at the end, because I wanted to remind you, it is never a linear -- If someone does that, really, they're superhuman.

06:29 If they start at pre-contemplation and zip all the way around to maintenance and stay there.

06:33 They're amazing.

06:37 So let's talk about motivational interviewing.

06:40 This is where you express and show empathy.

06:42 It's what I was talking to you about in the earlier slides.

06:45 This is how you as a healthcare worker, can help someone resolve those feelings of, "Meh, I don't really care about changing this." and that pre-contemplation mode.

06:56 So a lot of times it comes from fear and insecurities.

06:59 And people really need some help in finding that internal motivation.

07:03 I can't give motivation to anyone else.

07:06 I can, pump you up.

07:09 It won't last very long.

07:11 The goal of motivational interviewing is to help the patient find their own internal motivation that they need to change their behavior.

07:18 So it needs to be practical, right? None of this pie in the sky, singing songs to him stuff.

07:23 You want it practical, empathetic, and it's a short term process.

07:28 Got it? For all those of us that want to help fix everybody know that it has to be practical, does have to be empathetic, but it's a short term process.

07:38 The goal is to empower the patient not to be the one that fixes them.

07:44 So want to take into consideration how difficult it is to make these life changes but keep it practical, empathetic and short term.

07:52 So here's how it works.

07:53 You show empathy towards your clients.

07:55 You support and develop what's going on with the discrepancies.

07:59 You see this as where you want to be, yet this is where you are.

08:03 So let's figure out how we can deal with these discrepancies.

08:06 Then you start addressing the resistance.

08:08 Why is it that they don't want to do it? And you don't ask it like that.

08:12 So why don't you want to lose weight? You would say, "What do you think makes it difficult for you? What are the biggest barriers or challenges that you're finding there?" Then you help them with supporting their self-efficacy.

08:25 If you're not familiar with that term, self-efficacy is what I believe about what I can accomplish.

08:31 Man, some days I struggle with it, because I wonder like, how can I even dress myself today just don't feel like I can pull it off.

08:39 But you need to come behind the patient and look for other areas in their life where they have been successful, no matter how small because the research tells us that can transfer to other situations.

08:52 So give them genuine support of their self-efficacy or their ability to do it.

08:57 Then help them develop autonomy.

09:00 Doing it by themselves.

09:02 So you offer them some guidance, ask them important questions that are empathetic.

09:06 But remember, this is supposed to be a short process.

09:10 You want them to take over and feel empowered and make those changes autonomously.

09:17 Now, here's a very common diet that we teach patients with hypertension.

09:21 It's dietary approaches to stop hypertension.

09:25 That's why it's called the DASH diet.

09:27 Now, the reason it's good is because it promotes healthy balanced eating that includes plenty of fruits, vegetables, and low fat dairy foods.

09:36 Because fresh produce is high in potassium, magnesium, and calcium.

09:41 And those have been shown to play a pretty good role in lowering blood pressure.

09:45 So you can do a lot of things for your health through your diet.

09:48 Now I've listed options here for you six date serving, or grams per day.

09:53 I've got the options here for you that you can see and I won't go through these individually because you can look at these at another time, But know that this is what's involved in the dietary approach to stop hypertension or the DASH diet.