A unique New Zealand training program is changing the way nurses, GPs and allied health professionals communicate with their patients. These healthy conversations are enabling patients to drive their own behaviour change, writes Karen Keast.


Barbara Docherty is working to turn practitioner to patient interaction on its head.

The former practice nurse and now director of the TADS (Training and Development Services) Behavioural Health in New Zealand says it’s vital nurses, GPs and allied health professionals learn an entire new way of communicating with patients about their unhealthy behaviours.

Ms Docherty, an honorary clinical lecturer at the University of Auckland’s

School of Nursing, says a new language of patient engagement that enables patients to drive the change process from the earliest encounter is the key to transforming patients’ lifestyle behaviours.

“One of the biggest issues for patients and practitioners alike in primary health care, in life really, is how to crack the unhealthy behaviours which are so prominent and early in premature deaths,” she says.

“A lot of us are focused on tobacco and alcohol, other drugs, obesity and diabetes.

“Primary care health nurses and nurses who work in general practice settings can make a huge difference to this by changing the way that they actually have the conversations.

“It’s taking away that prominence around giving advice and instruction, and expecting that people are going to just obviously follow and change their unhealthy behaviours.”

Ms Docherty, who recently spoke on the topic at the Australian Primary Health Care Nurses Association’s (APNA) sixth national conference, says the current method often doesn’t work, resulting in poor outcomes for patients.

She says TADS research shows practitioners who enter a patient’s world, interpret the behaviour through their own professional lens and then apply corrective actions are missing crucial productive opportunities.

“People know that as soon as they enter a general practice setting, for example, that they are going to be targeted - they are going to be screened, asked if they are smoking or drinking or whether they are overweight or whether they gamble,” she says.

“As soon as that happens a barrier is built up immediately and they don’t want to be preached to, they don’t want to be told what to do - they want to actually find a way of driving it for themselves.

“So, one of the largest pieces of our research was finding a way of legitimately entering their world of personal behavioural practices and starting the conversation that was going to be non-threatening and non-invasive.”

Through the university, Ms Docherty worked on a World Health Organisation project focusing on the provision of brief intervention through “short, sharp, snappy conversations” with patients in primary health care, for behaviour change to tobacco, alcohol and other drugs.

Ms Docherty and her colleagues also embarked on a project to canvass the thoughts of around 2500 patients about what they wanted from their practitioner to patient conversations.

As a result, they found brief conversations and an approach to behavioural interventions that transfers the power in the change process from the practitioner to the patient, from the outset, can more likely result in positive patient lifestyle choices.

Ms Docherty says her research showed questions such as - ‘are you still going to the gym?’ resulted in incorrect answers.

“The patient would say ‘yes’ and then I turned the questions around,” she explains.

“I said ‘what are you enjoying about going to the gym?’ and the patient would say - ‘actually I’m not going’.”

Ms Docherty says she also asked a young male patient, who had been drinking heavily and putting on weight, ‘how much alcohol are you drinking now?’.

“This young man said ‘none’ and when I said ‘what’s the biggest benefit you are getting from not drinking so much alcohol?’, he immediately said - ‘I am drinking; I love it, I go out with my mates every Friday’.

“So it changed completely the outcome of that study we were doing, just by changing the question.”

The team went on to develop and validate resources that health professionals have since been accessing, through a three-day TADS training program, for the past seven years.

The training is designed to provide health professionals with a time-efficient and cost effective approach to behavioural interventions.

Ms Docherty says the approach doesn’t require any additional appointments - instead it can be utilised during the course of other work being carried out with the patient.

She says nurses have to start with what the patient wants.

“You have got to be able to carry that right through to the bitter end basically, until the person has made the decision to have a sustainable lifestyle behaviour change,” she says.

“One of the main things patients asked us to develop…was a picture of themselves in terms of their life and their lifestyle behaviours, and we also include mental health risks.

“So we developed a resource which allowed them to get that picture but the difference is that health practitioners never see the answer - it’s kept to them, it’s private to them.”

Ms Docherty says nurses have to stop driving the process, including giving advice and instruction.

“Without knowing how to have the conversation, we just keep going back and making the same mistakes all of the time,” she says.

“Changing the language is the most significant part of the puzzle, which is what the patients continuously said.

“Instead, we’ve been putting forward our preferred course of action onto our patients.

“If it’s led by the person, the patient, and not by the nurse, this will change the behaviour of the patient.

“If we change our attitudes and behaviour that changes the behaviour of the patients.”