fullerton grant #07-15 © melanie bunn rn, msn 1 home care chronic disease prevention program a...

Fullerton Grant #07-15 © Melanie Bunn RN, MSN© Melanie Bunn RN, MSN 11

Home Care Home Care Chronic DiseaseChronic Disease

Prevention ProgramPrevention Program

A collaboration of Duke University and University A collaboration of Duke University and University of South Carolina School of Medicineof South Carolina School of Medicine

Fullerton # 07-15Fullerton # 07-15


Chronic Disease ManagementChronic Disease Management

Module 1:Health/Illness, Vital Signs, Exercise, Module 1:Health/Illness, Vital Signs, Exercise, NutritionNutrition

Module 2: Motivational InterviewingModule 2: Motivational Interviewing Module 3: End of LifeModule 3: End of Life Module 4: Heart AttackModule 4: Heart Attack Module 5: COPDModule 5: COPD Module 6: StrokeModule 6: Stroke Module 7: HypertensionModule 7: Hypertension Module 8: DiabetesModule 8: Diabetes Module 9: Congestive Heart FailureModule 9: Congestive Heart Failure


Module 7:Module 7:HypertensionHypertension


ObjectivesObjectives

Define HTN and its impact on healthDefine HTN and its impact on health

Describe healthy lifestyle choices for the Describe healthy lifestyle choices for the person with HTNperson with HTN

Demonstrate use of motivational Demonstrate use of motivational interviewing with the person with HTNinterviewing with the person with HTN


HypertensionHypertensionAlso known as high blood pressureAlso known as high blood pressureSometimes called “high blood”Sometimes called “high blood”Abbreviation: “HTN”Abbreviation: “HTN”About one in three older Americans have About one in three older Americans have

high blood pressurehigh blood pressure


What is blood pressure?What is blood pressure?Blood pumped from the heart to all parts of Blood pumped from the heart to all parts of

the body via arteriesthe body via arteriesThe blood pressure is the force of the The blood pressure is the force of the

blood pumped against the arteriesblood pumped against the arteriesThe number is represented as two The number is represented as two

numbersnumbersThe systolic pressure is the pressure when The systolic pressure is the pressure when

the heart pumps (top number)the heart pumps (top number)The diastolic pressure is the pressure when The diastolic pressure is the pressure when

the heart rests (bottom number)the heart rests (bottom number)


Blood PressureBlood Pressure

Blood pressure changes during the dayBlood pressure changes during the day It can rise with stress and emotionIt can rise with stress and emotion It is typically lowest during sleepIt is typically lowest during sleep


What is normal?What is normal?

Blood pressure is always reported as a Blood pressure is always reported as a systolic and a diastolic number and both systolic and a diastolic number and both are importantare important

A BP at or below 120/80 is normalA BP at or below 120/80 is normalPre-hypertension is 120-139/ 80-89Pre-hypertension is 120-139/ 80-89Stage one : 140-159/ 90-99Stage one : 140-159/ 90-99Stage two: greater than 160/100Stage two: greater than 160/100


How is it measured?How is it measured? SphygmomanometerSphygmomanometer Do not drink coffee or smoke Do not drink coffee or smoke

cigarettes 30 minutes beforecigarettes 30 minutes before Sit for 5-15 minutes before the testSit for 5-15 minutes before the test Sit with back supported and feet flat Sit with back supported and feet flat Arm should be at the level of the Arm should be at the level of the

heartheart Use the right size cuff to ensure an Use the right size cuff to ensure an

accurate readingaccurate reading


Etiology: What causes it?Etiology: What causes it?Majority of cases are essential (unknown Majority of cases are essential (unknown

etiology)etiology)Some cases are due to other causesSome cases are due to other causes

MedicationsMedicationsDrugsDrugsPrimary kidney diseasePrimary kidney diseaseTumorsTumors


Who is at risk?Who is at risk?

African Americans African Americans Persons who are overweightPersons who are overweightPersons who smokePersons who smokePersons who have a family history of high Persons who have a family history of high

blood pressureblood pressureMenMen


Signs and SymptomsSigns and Symptoms

Often, NONE!!!Often, NONE!!!Typically silent, no symptomsTypically silent, no symptomsHeadache, blurred vision, chest pain, Headache, blurred vision, chest pain,

shortness of breath, kidney damageshortness of breath, kidney damage


ComplicationsComplicationsHeart can get larger from the work Heart can get larger from the work

overload leading to heart failureoverload leading to heart failureBlood vessels in the kidney narrow leading Blood vessels in the kidney narrow leading

to kidney failureto kidney failureArteries throughout the body narrow Arteries throughout the body narrow

leading to heart attacks, strokes, leading to heart attacks, strokes, amputationsamputations

Bulges can form in blood vessels Bulges can form in blood vessels (aneurysm) and they can burst (aneurysm) and they can burst (hemorrhage)(hemorrhage)


PreventionPrevention

Healthy weightHealthy weightExerciseExerciseDASH dietDASH dietQuit smokingQuit smokingLimit alcoholLimit alcoholLimit sodiumLimit sodium


TreatmentTreatment

MedicationsMedications

Healthy dietHealthy diet

Exercise and weight lossExercise and weight loss

Quit smokingQuit smoking

Limit alcohol intakeLimit alcohol intake


MedicationsMedications

Diuretics (“water pills”)- decrease the Diuretics (“water pills”)- decrease the excess salt and water in the body to excess salt and water in the body to decrease the blood pressuredecrease the blood pressure

Beta blockers- cause the heart to beat Beta blockers- cause the heart to beat slower and decreases the pressureslower and decreases the pressure

Ace inhibitors- decrease the level of an Ace inhibitors- decrease the level of an enzyme that narrows blood vesselsenzyme that narrows blood vessels

Calcium channel blockers- relaxes blood Calcium channel blockers- relaxes blood vessels vessels


DASH DietDASH Diet

Diet low in saturated fat, cholesterol, total Diet low in saturated fat, cholesterol, total fat, red meat and sugared beveragesfat, red meat and sugared beverages

Diet high in fruits, vegetables, low fat Diet high in fruits, vegetables, low fat dairy, whole grain, fish, poultry, and nutsdairy, whole grain, fish, poultry, and nuts

Lowers cholesterolLowers cholesterol


Serving RecommendationsServing Recommendations

2,000 kcal diet2,000 kcal diet7-8 servings of grains and grain products7-8 servings of grains and grain products4-5 servings of vegetables4-5 servings of vegetables4-5 servings of fruits4-5 servings of fruits2-3 servings of low fat dairy2-3 servings of low fat dairy2 or less (3 ounces cooked) of meat, 2 or less (3 ounces cooked) of meat,

poultry, or fishpoultry, or fish1 serving of nuts/seeds1 serving of nuts/seeds2-3 servings of fats, oils2-3 servings of fats, oils


Sodium Sodium

Recommended intake:Recommended intake:Less than 2,400 mgLess than 2,400 mgNo more than one teaspoon No more than one teaspoon

Keep in mind that:Keep in mind that:Processed foods are high in saltProcessed foods are high in saltCanned foods should be rinsedCanned foods should be rinsedFrozen foods and meals are high in saltFrozen foods and meals are high in salt


Living with HTNLiving with HTN

Keep track of measurementsKeep track of measurements Take medications as prescribed by your doctorTake medications as prescribed by your doctor Report symptoms and side effects of Report symptoms and side effects of

medicationsmedications Chose healthier lifestyle choicesChose healthier lifestyle choices Women and HTNWomen and HTN

PregnancyPregnancy Oral contraceptivesOral contraceptives Post menopausal hormone therapyPost menopausal hormone therapy


HTN Warning Symptoms HTN Warning Symptoms

Shortness of breathShortness of breathChest painChest painHeadacheHeadacheVisual changesVisual changes


Warning SignsWarning SignsDecreased blood pressure (less than Decreased blood pressure (less than

90/60)90/60) Increased blood pressure ( greater than Increased blood pressure ( greater than

160/100)160/100) Increased pulse (greater than 100)Increased pulse (greater than 100)Decreased pulse (less than 60)Decreased pulse (less than 60)Other warnings: not taking medicationsOther warnings: not taking medications

**Note:Note: ALL vital parameters are determined by RN ALL vital parameters are determined by RN supervisor and are patient specificsupervisor and are patient specific


Case StudyCase Study

69 year old female with hypertension69 year old female with hypertensionTells you that her blood pressure is poorly Tells you that her blood pressure is poorly

controlled but that she feels finecontrolled but that she feels fineShe goes on to tell you that she rarely She goes on to tell you that she rarely

takes her medications because she feels takes her medications because she feels so goodso goodWhat worries you about her behavior?What worries you about her behavior?What are possible complications of her What are possible complications of her

hypertension?hypertension?



Her blood pressures usually runHer blood pressures usually runSystolic 160-170Systolic 160-170Diastolic 96-118Diastolic 96-118

What stage of hypertension is she at?What stage of hypertension is she at?Stage I 140-159/ 90-99Stage I 140-159/ 90-99Stage II 160+/ 100 +Stage II 160+/ 100 +



What worries you about her behavior?What worries you about her behavior?

What are possible complications if she What are possible complications if she doesn’t better manage her hypertension?doesn’t better manage her hypertension?


Case StudyCase StudyWhat worries you about her behavior?What worries you about her behavior?

o She does not take her medicationsShe does not take her medicationso She is not worried about the effects of She is not worried about the effects of

hypertensionhypertensionWhat are possible complications of What are possible complications of

hypertension?hypertension?o Heart failureHeart failureo Kidney failureKidney failureo Stroke, heart attackStroke, heart attacko Blood vessels bulge and burstBlood vessels bulge and burst


Motivational InterviewingMotivational Interviewing

What could you do to assist her with What could you do to assist her with her medication compliance?her medication compliance?

First, you must gain her trust you, so First, you must gain her trust you, so you can start asking questions that you can start asking questions that will begin the change talk.will begin the change talk.


Starting the Change TalkStarting the Change Talk

What questions can we ask that could start What questions can we ask that could start her thinking about taking her medications?her thinking about taking her medications?

Try:Try:Tell me about your medications.Tell me about your medications.

What do you think about not taking your What do you think about not taking your medications?medications?


WILLING, ABLE, READYWILLING, ABLE, READY

In the next few slides, put yourself in this In the next few slides, put yourself in this client’s shoes. Answers to the following client’s shoes. Answers to the following questions from the patient’s point of view.questions from the patient’s point of view.


Find Out How Find Out How WILLINGWILLING She is to She is to ChangeChange

Ask open ended questions so she can:Ask open ended questions so she can:

o State her reasons State her reasons for not for not taking her taking her meds properlymeds properly

o State the reasons she has State the reasons she has forfor taking taking her meds properlyher meds properly

Have her write down her answers to these Have her write down her answers to these questions in the next several slidesquestions in the next several slides


What are her reasons for nWhat are her reasons for not ot taking her taking her meds? – 2 Good Questions to Ask meds? – 2 Good Questions to Ask

Reasons I have for Reasons I have for Staying the Same Staying the Same (Not Taking My Meds as Prescribed)(Not Taking My Meds as Prescribed)

Reasons I have to Reasons I have to Take My MedsTake My Meds

What benefits are you What benefits are you getting by not taking your getting by not taking your meds?meds?

What are your fears, What are your fears, concerns about taking your concerns about taking your meds as prescribed by your meds as prescribed by your doctor?doctor?

What are the worst What are the worst consequencesconsequences you can imagine if you continued to not you can imagine if you continued to not take your meds? (these are your fears, concerns about not taking your take your meds? (these are your fears, concerns about not taking your meds as prescribed)meds as prescribed)

What What benefitsbenefits could you get by taking your meds? Hint: Imagine what your could you get by taking your meds? Hint: Imagine what your life would be like if a miracle happened tomorrow and you were able to take life would be like if a miracle happened tomorrow and you were able to take your meds as prescribed by your doctor. your meds as prescribed by your doctor.


Sample Reasons for Not Taking Meds

Reasons I have for Reasons I have for Staying the Same (Not Staying the Same (Not Taking My Meds as Prescribed)Taking My Meds as Prescribed)

What benefits are you getting by not taking What benefits are you getting by not taking your meds?your meds?

I feel fine without taking my medsI feel fine without taking my meds

I have more money for food and rent and gasolineI have more money for food and rent and gasoline

What are your fears about taking your meds?What are your fears about taking your meds?

They make me feel funnyThey make me feel funny

I won’t have money for food and rentI won’t have money for food and rent


Explore Her Reasons FullyExplore Her Reasons Fully

Ask her how not taking her meds affects Ask her how not taking her meds affects all the various aspects of her life:all the various aspects of her life: Health,Health, Lifestyle,Lifestyle, Emotions,Emotions, Relationships,Relationships, Coping abilities (stress, for example),Coping abilities (stress, for example), Work,Work, Social life, andSocial life, and SpiritualSpiritual life life


Next, What reasons does she have for Next, What reasons does she have for takingtaking her meds? her meds?

Reasons I have for Reasons I have for Staying the Same (Not Taking Staying the Same (Not Taking My Meds as Prescribed)My Meds as Prescribed) Reasons I have to Reasons I have to Take My MedsTake My Meds

What benefits are you getting by not taking your What benefits are you getting by not taking your meds?meds?

What are your fears, concerns about taking your What are your fears, concerns about taking your meds as prescribed by your doctor?meds as prescribed by your doctor?

What are the worst What are the worst consequencesconsequences you can you can imagine if you continued to not take your imagine if you continued to not take your meds? (these are your fears, concerns about meds? (these are your fears, concerns about not taking your meds as prescribed)not taking your meds as prescribed)

What What benefitsbenefits could you get by taking your could you get by taking your meds? Prompt: Imagine what your life would meds? Prompt: Imagine what your life would be like if a miracle happened tomorrow and be like if a miracle happened tomorrow and you were able to take your meds as you were able to take your meds as prescribed by your doctor. prescribed by your doctor.


Some Sample Reasons for Taking MedsReasons I have for Reasons I have for Take My MedsTake My Meds

What are the worst What are the worst consequencesconsequences you can imagine if you can imagine if you continued to not take your meds? you continued to not take your meds? StrokeStrokeHeart attackHeart attackKidney damage – kidney dialysis like my friendsKidney damage – kidney dialysis like my friendsLose my ability to be physically activeLose my ability to be physically active

What would your life be like if a miracle happened and What would your life be like if a miracle happened and you started to take your meds tomorrow?you started to take your meds tomorrow?Feel that I could get into a regular physical activity routineFeel that I could get into a regular physical activity routineWouldn’t have to worry about having a stroke, heart Wouldn’t have to worry about having a stroke, heart attack, or further kidney damageattack, or further kidney damageHelp keep my diabetes from damaging my organ Help keep my diabetes from damaging my organ systems (if has diabetes)systems (if has diabetes)


Explore Her Reasons FullyExplore Her Reasons FullyAsk her how taking her meds could affect Ask her how taking her meds could affect

all the various aspects of her life:all the various aspects of her life: Health,Health, Lifestyle,Lifestyle, Emotions,Emotions, Relationships,Relationships, Coping abilities (stress, for example),Coping abilities (stress, for example), Work,Work, Social life, andSocial life, and SpiritualSpiritual life life


Next, Assess:Next, Assess:How important is it for her to change?How important is it for her to change?

Ask her to compare her reasons for Ask her to compare her reasons for not changing with her Reasons for not changing with her Reasons for changingchanging

Have her assign a number to the Have her assign a number to the Ruler of ChangeRuler of Change in the next slide. in the next slide.

This will show how important it is for This will show how important it is for her to changeher to change


How important is it for you to change?How important is it for you to change?

On a scale of 0 to 10, how important is On a scale of 0 to 10, how important is it to you to take your medications?it to you to take your medications?

The “Ruler of Change”The “Ruler of Change”

00 11 22 33 44 55 66 77 88 99 1010Not at allNot at all Very ImportantVery Important


WillingWilling

• This number on the Ruler of Change will show how WILLING she is to change

• It will show how willing she is to take her medications per the doctor’s instructions


Willing Willing (continued)(continued)

• If her Ruler of Change number is below 3 or 4, she is not willing to consider change.

• She has lots of resistance to change

• Her reasons for not taking her meds are STONGER THAN her reasons for changing.


Sample Question to Help Sample Question to Help Decrease ResistanceDecrease Resistance

What would have to change to decrease the importance you give for your reasons for not taking your meds?


Questions to Decrease ResistanceQuestions to Decrease ResistanceA low number on the ruler of change says A low number on the ruler of change says

she does not think that taking her she does not think that taking her medications is important and she does not medications is important and she does not want to changewant to change

But, look at her number on the Ruler of But, look at her number on the Ruler of ChangeChange

If she’s not at zero, she must have at least If she’s not at zero, she must have at least a small interest in change.a small interest in change.


Decreasing ResistanceDecreasing Resistance

• If this is the case, Ask:

o Why are you at ___ and not zero?

o What would it take for you to go from__ to__ ?

• Her answers might get her to start thinking that change might be a good thing



If the number the client gives for the importance of changing is around 5:

• She is “on the fence.”

• She is split between wanting to take action and not being able to take the first step.

• She is unable to change in her condition


Sample Question to Help Increase Sample Question to Help Increase MotivationMotivation

What would have to change to increase the importance of the reasons you have for taking your meds?



If the number she gives for the importance of change is greater than 6 or 7:

– She is not resistant to change

– She is not “on the fence”

– She is ready to take some action


Next, Find out if She is Next, Find out if She is ABLEABLE

Measure her Measure her ConfidenceConfidence and and AbilityAbility to Take her meds properlyto Take her meds properly

Use the Confidence and Ability Use the Confidence and Ability “Rulers of Change”“Rulers of Change”


Assessing Confidence and Ability to Assessing Confidence and Ability to Make a ChangeMake a Change

Score your Score your confidenceconfidence to take your meds to take your meds properly.properly.

Score your Score your abilityability to take your meds properly. to take your meds properly.

Handout : How Can I Quit Smoking?

00 11 22 33 44 55 66 77 88 99 1010

NoneNone LowLow MediumMedium Very HighVery High

00 11 22 33 44 55 66 77 88 99 1010



For Scores of 6 and BelowFor Scores of 6 and Below

Ask, “What would it take to increase Ask, “What would it take to increase your confidence to take your meds your confidence to take your meds properly?”properly?”

What encourages you to believe that you What encourages you to believe that you can achieve your goals for change?can achieve your goals for change?

Ask, “What would it take to increase Ask, “What would it take to increase your ability to take your meds your ability to take your meds properly?”properly?”


Increasing Confidence and Increasing Confidence and Ability About ChangeAbility About Change

Other questions to ask:Other questions to ask:

““What else would help you make changes?”What else would help you make changes?”

““Who else could help you make changes?”Who else could help you make changes?”

Adapted from Miller and Rollnick, Motivational Interviewing, 2002Adapted from Miller and Rollnick, Motivational Interviewing, 2002


For Low Confidence and Ability ScoresFor Low Confidence and Ability Scores

Maybe the goal is not realistic, it exceeds her confidence and ability. Ask:

o “What would happen if you reduced the size of your goal?”

o “What would you be willing to try?”

o “Maybe if you reduced your goal for changing, you would be more likely to try.”


The Next Step: Being The Next Step: Being READYREADY

• If she’s WILLING (Importance Score 5 and above)

• If she’s ABLE (Confidence and Ability Scores are 5 and above)

• Then she’s READY


Being Being READY READY Means:Means:

• Being READY to set a goal and make a plan

• Keeping track of progress on the goal

• Being prepared for setbacks with the right attitude and a plan “B”


Setting and Planning a Goal – Setting and Planning a Goal – SMART MethodSMART Method

• A useful method for setting goals, SMART.

• To be effective, Goals need to be:

o Specifico Measurableo Action orientedo Realistico Time


SMART Method – Some ExamplesSMART Method – Some ExamplesHow could you change the following statements into

SMART goals?

• “I will start walking” is not specific, measurable, nor has a time frame when the goal will be done.

• “I will cut out all added sugar in my diet” may be unrealistic – it might be more realistic to phase out slowly.


Set and Plan a Goal – SMART method Set and Plan a Goal – SMART method – Some Examples (continued)– Some Examples (continued)

• A SMART goal would be,

• “I will let my kitchen supply of salty snacks run out and replace them with fruits low sodium snacks over a 4 week period. At the same time I will reduce the salty snacks I eat when I’m away from home by one-half. In 4 more weeks I will replace the salty snacks I eat away from home with low sodium snacks I keep with me. I will satisfy my urge for salty snack only once a week and only with 1 serving.”


Class Exercise – Goal SettingClass Exercise – Goal Setting

• Put yourself in the shoes of the client who is not taking their meds properly

• Using your current goal setting skills, write a goal for taking your meds correctly on the next slide


Write Down Your Personal Goal and Write Down Your Personal Goal and Plan Below, Using Your Own WordsPlan Below, Using Your Own Words


Set and Plan a Goal – SMART MethodSet and Plan a Goal – SMART Method

• Now try rewriting the goal for change according to the SMART method

• Use the next slide to write the goal

• Try to write from the view of the client in the case study who is not taking her meds


What is Your Smart Goal?What is Your Smart Goal?

• S

• M

• A

• R

• T


READY READY

READY also includes tracking progress in a written log or on a calendar

• Seeing concrete progress helps build confidence

• Helps identify what helped, what was difficult, what you learned


Progress Check (sample)Progress Check (sample)

My goal was_____________My goal was_____________ I was______ successful in reaching my I was______ successful in reaching my

goalgoalWhat helped______________What helped____________________________was difficult______________was difficult I learned that__________________I learned that__________________

Adapted from HIP CHA training, 2005Adapted from HIP CHA training, 2005


READYREADY

• READY also includes being prepared for setbacks and relapses back to old habits

• Plan for recovery from setbacks – have a “Plan B”

• Remember,

– Setbacks are chances for learning how to do things better,

– Setbacks are not failures.


READYREADY - Staying Ready and - Staying Ready and MotivatedMotivated

• When you make your goal, Don’t Forget to Reward Yourself

• A reward provides an incentive to stay motivated.

• “After I do this, I’ll…”


Last wordLast word

Your client’s change in behavior is a team Your client’s change in behavior is a team effort. As a team player,effort. As a team player,Make sure you communicate what you see, Make sure you communicate what you see,

hear, feel and your instincts tell youhear, feel and your instincts tell youMake sure you communicate what you do and Make sure you communicate what you do and

what happenswhat happensMake sure you are working with the team on Make sure you are working with the team on

the patient’s goalsthe patient’s goals


What did you learn?What did you learn?

What is HTN and how does it impact What is HTN and how does it impact health?health?

What is a healthy lifestyle choices for the What is a healthy lifestyle choices for the person with HTN?person with HTN?

How would you use motivational How would you use motivational interviewing with the person with HTN?interviewing with the person with HTN?


How will what you’ve learned How will what you’ve learned change the way you do your job?change the way you do your job?

How will what you’ve learned How will what you’ve learned change your life?change your life?


Homework AssignmentHomework Assignment Think of another of your personal health Think of another of your personal health

improvement goals and fill out Handouts #1 to #5 improvement goals and fill out Handouts #1 to #5 and turn in next session:and turn in next session:

o Handout #1: Reasons for staying the same and changingHandout #1: Reasons for staying the same and changingo Handout #2: How important is change to me?Handout #2: How important is change to me?

Answer the question: How could I increase the Answer the question: How could I increase the strength of my reasons for changing and decrease strength of my reasons for changing and decrease those for staying the same?those for staying the same?

o Handout #3: How confident and able am I?Handout #3: How confident and able am I? Answer the question: What could increase my Answer the question: What could increase my

confidence and ability?confidence and ability?o Handout #5: My health improvement goal using the Handout #5: My health improvement goal using the

SMART methodSMART method


Handout #1

Reasons I have for Reasons I have for Staying the SameStaying the Same Reasons I have to Reasons I have to ChangeChange

What What benefitsbenefits are you getting by staying the are you getting by staying the same?same?

What are your What are your fears, concerns fears, concerns about taking about taking the actions needed to change?the actions needed to change?

What are the worst What are the worst consequencesconsequences you can you can imagine if you continued to stay the same? imagine if you continued to stay the same? (these are your fears, concerns about not (these are your fears, concerns about not changing)changing)

What What benefitsbenefits could you get by changing? could you get by changing? Hint: Imagine what your life would be like Hint: Imagine what your life would be like if a miracle happened tomorrow and you if a miracle happened tomorrow and you could make changes. could make changes.


Handout #2 – Measuring Importance of ChangeHandout #2 – Measuring Importance of Change

• On a scale of 0 to 10, how important is it for you to make a change in this health behavior?

00 11 22 33 44 55 66 77 88 99 1010

Not Not important important at allat all

Very ImportantVery Important


Handout #3 Confidence and Ability to Make a Behavior Handout #3 Confidence and Ability to Make a Behavior ChangeChange

Score your Score your confidenceconfidence to make the behavior to make the behavior change.change.

Score your Score your abilityability to make the behavior to make the behavior change.change.

00 11 22 33 44 55 66 77 88 99 1010


00 11 22 33 44 55 66 77 88 99 1010



Handout #4:Handout #4:

Write Down Your Personal Goal and Plan Write Down Your Personal Goal and Plan Below, Using Your Own WordsBelow, Using Your Own Words


Handout #5: Re-Write Your Goal Using SMARTHandout #5: Re-Write Your Goal Using SMART

• S

• M

• A

• R

• T


ReferencesReferences Neal, LJ. & Guillett, SE .Care of the adult with a chronic illness or Neal, LJ. & Guillett, SE .Care of the adult with a chronic illness or

disability. Mosby, St. Louis, Missouri, 2004. disability. Mosby, St. Louis, Missouri, 2004. pp 181-189.pp 181-189.

Kennedy – Malone, L. et al. Management guidelines for Kennedy – Malone, L. et al. Management guidelines for gerontological nurse practitioners. F.A. Davis Company, gerontological nurse practitioners. F.A. Davis Company, Philadelphia, PA, 2000. Philadelphia, PA, 2000. pp 167-172. pp 167-172.

Lippincott, Williams and Wilkins. Managing chronic disorders. Lippincott, Williams and Wilkins. Managing chronic disorders. Lippincott Williams and Wilkins, USA, 2006. Lippincott Williams and Wilkins, USA, 2006. pp 181-186 pp 181-186

Chobanian AV, , Bakris GL, , Black HR, et al. The Seventh Report of , et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72.2003;289(19):2560-72.

http://www.nhlbi.nih.gov/health/public/heart/index.htm#hbp http://www.americanheart.org/presenter.jhtml?identifier=2114http://www.americanheart.org/presenter.jhtml?identifier=2114


ReferencesReferences

HIP CHA training, 2005HIP CHA training, 2005 Miller, W.R. and Rollnick, S. Motivational Interviewing. New York: Miller, W.R. and Rollnick, S. Motivational Interviewing. New York:

Guilford Press,2002Guilford Press,2002 Botelho, R. 2002. Motivate Healthy Habits.Botelho, R. 2002. Motivate Healthy Habits.

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