Being Willing to Really Listen Can Help Those Facing Extreme Disparities and Challenges
Jan 9, 2015, 9:00 AM, Posted by Malia Davis
Malia Davis, MSN, RN, is a nurse practitioner and the director of nursing and clinical team development at Clinica Family Health Services in Lafayette, Colorado. She has cared for patients in the community, including those who are homeless, for more than a decade. She is a 2014 Robert Wood Johnson Foundation Executive Nurse Fellow.
Social and economic disparities define my work each day, and have provided powerful motivation for me to commit my professional life to attempts to minimize these disparities in the health care setting. Community health centers, which provide health care for the homeless, are where some of the sickest and poorest people in our communities seek medical and behavioral health care from people like me, a nurse practitioner who is honored to serve each of these individuals and families.
I believe one common misperception is that some of my patients fail to contribute to society. Working in community health care for 12 years—10 of them serving homeless people—I have found that most people are very hardworking. Many work at day labor and other low-wage, temporary jobs that are physically demanding and fraught with challenges of all kinds. I often hear of workers experiencing abuse, failing to get paid, and experiencing unsafe working conditions.
They have, of course, none of the benefits we usually associate with jobs. Instead, they face the stress of not knowing day to day if they will find work and be able to support their families—or not. This stress is often compounded by the personal experience of witnessing, surviving, and overcoming trauma or violence, often while in poverty and with very limited resources for healing physically or emotionally.
I often leave work incredibly grateful for my life and the opportunities I have. More so, I am astounded that people continue to be able to love, laugh, be kind, and try to be the best people they can be in the midst of seemingly insurmountable disparities and obstacles. Often, I find my patients’ perseverance and survivorship to be remarkable. They create bridges from disparities to resilience through strength and perseverance. It is something steady that they do reliably over time. They grow it, they live it.
So what then, do we do when their personal health, and/or the health of the community they live in, is terrible? When multiple chronic illnesses cause them to struggle with poor or worsening health? Where is the bridge for this? How can we translate the illness of each of these people into real wellness? How do we get to a Culture of Health that includes the people I see and treat?
Eating vegetables and taking Zumba classes have spread like a virus, and it is a beautiful thing.
There are a series of questions that I have started to ask patients that have helped me value the priorities in their lives (the daily stuff) more deeply, even as I encourage them to change (i.e. take medications properly, lose weight, quit smoking, get recommended screening tests, etc.). These questions are rooted in the theory of Motivational Interviewing and they might be a significant tool in primary care to help patients come to their own goals and measures of success for change. I find that these questions can free us from "telling" and lead us instead to "stewarding" successful change. This can translate into true change regarding health care goals, even for our sickest patients. Here are some of the questions I ask:
- What change do you want to make?
- Why would you want to make change?
- How might you go about it, in order to succeed?
- What are the three best reasons for you to do it?
- How important is it for you to make this change?
- So what will you do?
When I asked one patient what she could do, she said: ‘I can dance.’ Suddenly my patient with obesity and diabetes is teaching a free or donation Zumba class in her neighborhood! She is off her medications and has lost 45 pounds. She is teaching many other women how good it feels to be physically active, how exercise helps control diabetes. They laugh together at class, their sons come with them to dance! Now one son teaches Zumba at his high school. Eating vegetables and taking Zumba classes have spread like a virus, and it is a beautiful thing. This is real change ... this is change that makes her, her neighbors, her school, her kids, their kids navigate us toward a Culture of Health.
Motivational Interviewing can be a key to knowing where we come from and where we might like to go, with the direction defined by the person living it. This becomes a deep connection that is more powerful than any patient plan filled with directions from me about what she should do to change. It is more powerful because she has written it.
I read her story and celebrate. With Motivational Interviewing, we must ask open-ended questions and be willing to truly listen. Ask what the most important change regarding someone’s physical or mental health might be. Listen. Then use these questions to start. It gets easier each time you do it.
This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.