Effective Path:
COACH: Let’s get back to your conversation with Gregory. You’ve been able to discuss his motivations, now use the skills you’ve learned to discuss his barriers to change and collaborate on a plan.
CLARKE: You’ve put a lot of work in to stay smoke free and take your medication, which should make a big difference.
GREGORY: I appreciate that. I’m trying. I guess it could be making a difference.
CLARKE: Given all you have accomplished so far, it seems like it is.
GREGORY: Maybe so.
GREGORY’S THOUGHT: When I wanna step up, I get it done. No doubt about it.
COACH: Nice! Your affirmation mentioned specifically what Gregory has done for his health which helped him feel appreciated and capable.
CLARKE: Sounds like you’re open to thinking about what next steps might look like.
COACH: Nice! Your reflection picked up on Gregory’s change talk.
GREGORY: Yeah, I’m ready. Let’s do it.
CLARKE: So, in terms of ways to continue improving your cardiovascular health, what are your thoughts?
COACH: Nice! By keeping the question open ended, you allow Gregory to identify options that he is more likely to choose and follow through with.
GREGORY: Well, at first I thought the rehab program would be okay. I liked the sense of community.
CLARKE: What happened when you tried our cardiac rehab program?
GREGORY: I was starting to feel better. But it just didn’t feel right.
CLARKE: What didn’t feel right?
GREGORY: It was like, they were treating us all the same! And I didn’t like how they were, talking down to us, and expecting us to fall into line. We were sheep to them.
COACH: Good job! By asking Gregory an open ended question, you gave him the space to express himself and answer honestly.
CLARKE: It sounds like the lecturing was a problem for you, while at the same time, you got some initial benefits.
GREGORY: I did like that part a lot. One time, ah, I forget her name, “I put lettuce and tomato on every burger I eat.” When she said that wasn’t good enough, he stood up and pointed to the poster on the wall. “Y’see that? Lettuce and tomato. I rest my case” (laughs) We enjoyed that. (laughs) Feels like moments like that make the tough parts a little easier.
GREGORY: Yeah, I mean, it might be worth giving it another shot. I’ll have to think on it. Keep in mind what’s important to me.
COACH: Great! Your double sided reflection showed Gregory you were actively listening to his concerns and led to him expanding on what he liked about the program.
CLARKE: Like, being able to be active with your family.
GREGORY: I do wish I could have the energy to play with my grandkids. I, I’d like them to be able to keep thinking of me the same as I was before, as much as possible.
COACH: Great! You accurately identified and reflected what Gregory said is important to him, which evoked change talk about follow through and self care.
GREGORY: And I guess it’s really my choice, whether or not I want to give the rehab program another try.
GREGORY: I think the program might be worth another try.
CLARKE: That sounds like a good choice.
GREGORY: But I could see myself doing more for my health, outside the rehab program too.
CLARKE: Okay. Sure.
CLARKE: I’d like to work together and set a specific, measurable goal that you can try to achieve over the next couple weeks. How’s that sound?
COACH: Asking how Gregory feels about setting a specific goal is a good way to foster collaboration and effective action planning.
GREGORY: That sounds good. What kind of goal?
CLARKE: Well, other than being specific and measurable, it should be realistic. We don’t want to aim for something you don’t feel you’ll be able to hit.
GREGORY: Got it. Uhh, I might need a moment to think about it.
CLARKE: That’s fine.
CLARKE: You mentioned earlier working on physical activity, limiting fried foods, and cutting back on alcohol. All those are good ideas to consider.
COACH: Asking an open ended question like “what would you like to focus on” encourages Gregory to develop a plan that works best for him, which he is more likely to want to follow.
GREGORY: I think I’d be open to getting more exercise, if I wanted to do something.
CLARKE: What do you think you could do to get more exercise?
GREGORY: I mean, I could try golfing more, when I have a little more energy.
CLARKE: Okay. So you want to get more exercise, and eventually golf more. With that in mind, what would be a small step that could get you started?
GREGORY: Uh, I could go with my wife when she goes for a walk every morning before breakfast, and every night after dinner.
CLARKE: How realistic is the goal to join your wife on her daily walks?
GREGORY: Well, sometimes I go over to my neighbors to watch a game, or play cards. So, I guess it is not that realistic to go every day.
CLARKE: Well, we want to try and set a goal you feel is doable.
GREGORY: I could shoot for going with her 4 times a week, starting this weekend. That feels doable, at least as a start.
COACH: Asking an open ended question like “how realistic is it” gives Gregory the space to consider all the possibilities of whether or not he has set a goal he can realistically achieve.
CLARKE: I’d like to make sure you’re gradually increasing your physical activity. How long does your wife usually spend walking? And how fast does she go?
GREGORY: Usually a half hour, right as the sun is going down. It’s pretty around then, and a decent temperature. And she’s a pretty intense woman. When we’ve walked in the past, I’ve worked up a bit of a sweat. Nothing too crazy.
CLARKE: So your wife doesn’t push you too hard, just hard enough to get good exercise.
GREGORY: Yeah.
CLARKE: How will you keep track of how often you’re walking?
GREGORY: I guess. I could make a note of it in my calendar. Shouldn’t be a big deal.
CLARKE: Sounds good.
COACH: Asking open ended questions allows you and Gregory to develop a more specific, measurable, and realistic plan.
CLARKE: This goal seems reasonable. And every step counts.
GREGORY: All right. I feel good about that.
COACH: Great! By affirming Gregory’s efforts, you let him know he is on a path to effective change.
GREGORY: Maybe once I get started I can find some other ways to fit exercise in. You know, with my buddies. Some of them actually like to walk the course. I’ve been using a cart, but I know I don’t get much exercise with the cart.
CLARKE: That sounds like a great next step, whenever you feel ready for it.
GREGORY: Yeah. Thanks.
CLARKE: I think we’re done for today. Could you take me through the plan we talked about?
GREGORY: Okay, sure. I’m going to,
GREGORY: Go for a walk with my wife at least 4 times a week, starting this weekend,
GREGORY: We’ll go for around a half hour each time, enough to push myself a little,
GREGORY: As a stretch goal, when I’m feeling up to it, I might try to walk instead of taking the golf cart around,
GREGORY: I’m going to stay smoke free, and continue my medications,
GREGORY: And I’ll probably give the cardiac rehab program another try.
CLARKE: That all sounds good. I’ll set up a time to call you and check in over the next couple weeks, if that’s okay with you.
GREGORY: That sounds good to me. Thank you.
CLARKE: All right, thanks so much for talking, Gregory. When would be a good time around two weeks from now for me to call you and check in on how your goal is going?
GREGORY: Maybe two weeks from tomorrow, after four.
CLARKE: That sounds good. Thanks again for coming in today.
GREGORY: Sure thing.
COACH: Gregory left his appointment with a plan to go on some walks with his wife, and despite his mixed experiences the last time he tried the cardiac rehab program, he wanted to give it another shot.
COACH: Gregory was feeling pretty good after talking with Nurse Clarke. At his next checkup, he was still smoke free, did not have any new cardiovascular symptoms, and he was enjoying the walks with his wife. He even mentioned that he had met a new friend through the cardiac rehab program.
COACH: Now you can take a look at your performance dashboard, which will go into more detail about your choices throughout the conversation with Gregory.