mindset health behavior changemedia01.commpartners.com/coke/sept_9_2009/090909_slides.pdf ·...
TRANSCRIPT
A Continuing Education Program for Nursing and Nutrition Professionals
MINDSETA New Strategy for
Health Behavior Change
Carol S. Dweck, PhD
Stanford University
Author of Mindset: The New Psychology of Success
Lola Coke, PhD, APRN-BC, CNS
Rush University College of Nursing
Guest Speaker Moderator
Diane Quagliani, RD, MBA
Quagliani Communications, Inc.
Guest Speaker
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Thank you to our sponsor!
The Coca-Cola Company The Beverage Institute For Health & Wellness
This activity is presented by the Preventive Cardiovascular Nurses Association (PCNA) and sponsored by the Beverage Institute for
Health & Wellness
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
More Free CE Opportunities Online
From PCNA :
• Insulin Resistance
• Nutrition
• Women’s Health in Menopause
• Diabetes
• Triglycerides/HDL
• Angina
• Exercise Guidelines
To view these programs:
www.pcna.net
From The Coca-Cola Company Beverage Institute For Health & Wellness:
• Beverages & Bone Healthwith Dr. Robert P. Heaney
• Safety Review of Aspartame
• with Dr. Bernadene Magnuson
• Vitamin D & Chronic Disease Riskwith Dr. Michael F. Holick
To view these programs: www.thebeverageinstitute.org
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Accreditation
• The Coca-Cola Company Beverage Institute For Health & Wellness is a
Continuing Professional Education (CPE) Accredited Provider with the
Commission on Dietetic Registration (CDR) – provider number #BF001.
Dietetic professionals (RDs/DTs) will earn 1.0 CE Credit for participating in
this program.
• The Preventive Cardiovascular Nurses Association is accredited by the
American Academy of Nurse Practitioners as an approved provider of
nurse practitioner continuing education. Provider number: 030602. This
program was planned in accordance with AANP CE Standards and Policies
and AANP Commercial Support Standards. RNs/NPs will earn 1.25 CE Credit
participating in this program.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
• Use the MESSAGE box on the left of your screen to submit a question for the
Q&A Session
• Click on this icon for technical assistance.
• Click on this icon for program handouts.
• Click on this icon
before exiting this program today to access the Course Evaluation and
Obtain a CPE Certificate.* The CPE LINK will also be provided in a follow-up
email to all participants. Note: if you watched the webinar as part of a group
you will be able to obtain a CPE Certificate.
*This program is pre-approved for CPE for nursing and dietetic professionals. Other professionals may obtain a Certificate of Attendance by emailing [email protected]
or calling 1-800-274-9390
Housekeeping
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Moderator
Diane Quagliani, RD, MBAQuagliani Communications, Inc.
MINDSETA New Strategy for
Health Behavior Change
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
MINDSETA New Strategy for
Health Behavior Change
Carol S. Dweck, PhD
Lewis and Virginia Eaton Professor
of Psychology
Stanford UniversitySpeaker
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
“I don’t divide the world into the weak
and the strong, or the successes and the
failures… I divide the world into the
learners and nonlearners.”
- Benjamin Barber
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
• When it comes to weight and health, many
people are non-learners.
• We ask them to change…
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
• When it comes to weight and health, many
people are non-learners.
• We ask them to change...but they don’t
really believe they can.
How can we help people believe in
change and become learners?
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Mindsets
• Fixed Mindset: Your qualities are simply
fixed traits—you are what you are.
• Growth Mindset: Your qualities can be
developed—through effort and instruction.
…where you are now is just a starting point
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Mindsets
• Which mindset is correct?
• Do people hold the same mindsets across
different areas?
• Can mindsets be changed?
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
How Do Mindsets Work?
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
#1
Fixed Mindset:
I’M FINE THE WAY I AMPEOPLE WITH A FIXED MINDSET STAY IN THEIR COMFORT ZONE
Growth Mindset:
LEARN, LEARN, LEARN BETTER HEALTH BEHAVIORS
PEOPLE WITH A GROWTH MINDSET SEEK AND ACCEPT CHALLENGES
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
How a Fixed Mindset Turns
People Away from Learning
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Question “What is the capital of Australia?”
*Subject
types
response and confidence
1.5 s 2 s
*Correct
answer
1.5 s
Ability-Relevant
Feedback
Learning-Relevant
Feedback
1 s
Paying Attention to Learning
or
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
• People in a Fixed Mindset just want to
know they’re right
• People in a Growth Mindset want to know
what’s wrong and how they can fix it.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
He blamed his genes.
He blamed his parents’
eating habits.
He blamed the stress he
was under.
He blamed the fast food
companies.
Nothing was his fault or
his responsibility
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
IN A GROWTH MINDSET, A
PERSON RECOGNIZES
THAT:
MAYBE HIS GENES AREN’T
IDEAL
MAYBE HIS PARENTS HAD
BAD EATING HABITS
MAYBE TEMPTATIONS ARE
EVERYWHERE
BUT HE CAN, OVER TIME,
LEARN A HEALTH REGIME
THAT WORKS FOR HIM
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
#2
Fixed Mindset:
DON’T WORK TOO HARD—IT SHOULD COME NATURALLY
Growth Mindset:
EXPECT TO WORK HARD (AND TO KEEP WORKING HARD), EFFORT IS KEY
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
#3
IN THE FACE OF SETBACKS…
Fixed Mindset:
GIVE UP, MAKE EXCUSES, HIDE FROM THE TRUTH
Growth Mindset:
EXPECT SETBACKS, CONFRONT THEM, LEARN FROM THEM
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Mistakes = Lack of Ability, Bad
Person
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
IF THEY DO EMBARK ON A HEALTH REGIME AND
HIT SETBACKS…
FIXED MINDSET: IT WASN’T MEANT TO BE
IT WASN’T MY FAULT
IT DIDN’T HAPPEN…
GROWTH MINDSET:WHAT CAN I LEARN FROM THIS?
WHAT CAN I DO DIFFERENTLY NEXT TIME?
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
After a failure…
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Where Do Mindsets Come From?
Messages About What Is Valued
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Messages About What Is Valued
Person Praise: “Wow, that’s a really good
score. You must be smart at this.”
Process Praise: “Wow, that’s a really good
score. You must have tried really hard.”
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Effects of Person vs. Process Praise
• Mindset: Fixed vs. Growth
• Goals: Comfort zone vs. Learning
After Setbacks:
• Confidence: Low vs. High
• Performance: Decreased vs. Increased
• Rampant lying after person praise
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
IMPLICATIONS
• Communicate that what is valued is not just
the end product (e.g., weight loss), or the
“goodness” of the patient.
• But the process of stretching, learning, self-
correcting and maintaining that process over
time.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Changing Mindsets
Brainology
www.brainology.us
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Brain Experiments
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
The Learning Brain
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Application to Health Behavior
• Neural/brain pathways (habits) can be trained, etc.
• Patients need to stretch beyond their “comfort
zone”
• Patients need learn that health behavior change is a
process
• Health care providers can develop a plan with the
patient to deal with the setbacks and failures.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Conclusion
The belief in personal growth
allows individuals to:
• Embrace learning and challenges (vs. stay in
comfort zone)
• Capitalize on mistakes and feedback
• Understand the role of consistent effort in
creating and maintaining change
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Conclusion: Implications for Health Practitioners
• Teach about fixed and growth mindsets
• Focus on processes (effort, strategies,
learning) that can be maintained
• Teach patients to expect setbacks and to
capitalize on them
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Food For Thought…
What might you do differently
now with your patients?
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Lola Coke, PhD, APRN-BC, CNSAssistant Professor
Rush University College of Nursing
MINDSET& Behavior Change Theories
- A Behavior Change “Toolkit”
Impact of Mindset on Behavior Change to Promote Weight Loss
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Mindset
• Mindset can serve as a framework for Behavior
Change Theories:
– Assessment of Growth and Fixed Mindsets assist in
developing motivational strategies for behavior change.
– A Fixed Mindset impacts Precontemplation of the
Transtheoretical Model.
– A Fixed Mindset impacts Perceived Susceptibility in the
Health Belief Model.
– Self efficacy is better maintained in a Growth Mindset.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Behavior Change Theories:
Transtheoretical Model
♥ The Transtheoretical Model describes the stages of behavior prior to change.
♥ focuses on the individual’s decision making.
♥ involves the state of feeling, awareness, judgments, perceptions, and behavior.
♥ has been used in a variety of problem behaviors.
♥ five stages.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Behavior Change Theories:
Transtheoretical Model
♥ Precontemplation — The person has no intention to change or take action within the near future.
♥ Contemplation — The person intends to change within the next 6 months.
♥ Preparation — The person plans to take action within the next month.
♥ Action — The person has made significant modifications in his/her behavior and way of life.
♥ Maintenance —The person is not working as hard as the person in the Action mode, but is working to prevent a relapse. The person is confident of continuing to change.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Behavior Change
Theories: Social Cognitive
Theory and Self-Efficacy
Behavior
Personal Factors(cognitive, affective and biological events)
Environmental Factors
This clinical tool can be
used to evaluate patient
coping mechanisms and
confidence in ability to
change.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Behavior Change
Theories: Health Belief Model
♥ Reflects the psychological factors that effect a person’s
decision to participate with health services. It focuses
on the attitudes and beliefs of the individuals.
♥ Five areas that influence decision to seek assistance for
a health issue.
– Perceived Susceptibility
– Perceived Seriousness
– Perceived Benefits and Barriers
– Self Efficacy
– Cues to Action
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Patient Case Study
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Case Study: Johnnie B
♥ 68 year old African American female - works as a
grocery clerk part time
♥ Cares for 2 elementary school aged
grandchildren after school and full time during
the summer
♥ Referred to Preventive Cardiology for
cardiovascular risk factor reduction and
management of hypertension
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Johnnie’s Cardiovascular
Risk Assessment
♥ Family history of hypertension and stroke on both maternal and fraternal sides. States “I was sure I would get high blood pressure."
♥ BMI = 32, waist circumference = 42
♥ BP = 150/98, Pulse = 88
♥ Chest X-ray shows left ventricular hypertrophy
♥ 68 years old, menopausal
♥ Remaining review of systems is negative except for renal insufficiency and hypothyroidism; Has +2 edema bilateral lower extremities.
♥Medications: Hydrocholorothiazide 50 mg, and Lisinopril 25 mg daily for Hypertension; Synthroid .150mcg daily for Hypothyroidism.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Johnnie’s Cardiovascular
Risk Assessment (con’t)
♥ Lifestyle Physical Activity: Stands when at work, no exercise
routine. Walks 3 blocks to bus stop and 1 block to the store 2
days a week when working.
♥ Diet: Was given a pamphlet about the DASH diet, but does
not follow it. States, “Food doesn’t taste good without salt.”
♥ Stress: “I am very stressed, especially when I care for my
grandchildren..they don’t listen to me.”
♥ Medications: “I don’t take them every day because I can’t
afford it. I don’t feel bad when I don’t take them, so I take
them every other day to make the bottle last longer.”
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Laboratory Data
Lipoprotein Panel
TC 230 mg/dL
Trig 210 mg/dL
HDL 36 mg/dL
LDL 155 mg/dL
Non/HDL-C 194 mg/dL
Blood Chemistry Results
Potassium: 4.5 (3.5-5mEq/L)
Sodium: 155 (135-145 mEq/L)
Creatinine: 1.4 (.5-1.5 mg/dl)
BUN 67: (10-30mg/dl)
Fasting Glucose:103 (70-
110mg/dl)
What is Johnnie’s
Framingham Risk Score?
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 2001;285:2486.
Age (yr)
Years Points
20-34 -7
35-39 -3
40-44 0
45-49 3
50-54 6
55-59 8
60-64 10
65-69 12
70-74 14
75-79 16
CHD Risk
Points 10-yRisk (%)
<9 <19 1
10 1
11 1
12 113 2
14 2
15 3
16 417 5
18 6
19 8
20 1121 14
22 17
23 22
24 27
≥≥≥≥ 25 ≥≥≥≥30
Systolic Blood Pressure
Untreated Treated
<120 0 0
120-129 1 3
130-139 2 4
140-159 3 5
≥≥≥≥160 4 6
HDL-C (mg/dL)
Points
>60 -1
50-59 0
40-49 1
<40 2
Score = 21
Risk = 14%
LDL-C goal:
<130 mg/dL
Total Age (yr)
Cholesterol
(mg/dL) 20-39 40-49 50-59 60-69 70-79
<160 0 0 0 0 0
160-199 4 3 2 1 0
200-239 8 6 4 2 1
240-279 11 8 5 3 2
≥≥≥≥280 13 10 7 4 2
Cigarette Smoking
Nonsmoker 0 0 0 0 0
Smoker 8 7 4 2 1
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Patient Treatment Goals
♥ Dietary changes:
Reduce sodium to improve blood pressure
Reduce dietary fat
♥Weight loss:
Reduce caloric intake to decrease BMI and waist circumference
♥ Physical Activity
Initiate program of regular activity/exercise to assist with weight
loss, improve blood pressure and cardiovascular fitness.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Mindset Steps for Health Providers
• Teach about fixed and growth mindsets.
• Focus on processes (effort, strategies, learning) that
can be maintained.
• Teach patients to expect setbacks and to capitalize
on them.
• Communicate that what is valued is not just the end
product (e.g., weight loss), or the “goodness” of the
patient, but the process.
• The process of stretching, learning, self-correcting
and maintaining happens over time.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Using Mindset for Behavior Change
• Determine whether Johnnie has a Fixed or Growth Mindset
by asking questions like:
– How do you feel about your appearance?
– Does she think she is “doomed” because of her family history?
– Does she desire to learn more about changing her eating habits?
– How much of health has to do with your genes and heredity versus
your health practices and lifestyle?
– Do you think people are meant to be a certain weight and there is
nothing you can do to change it?
– How did you get to where you are (i.e. worked hard to maintain
weight but then gave up)?
– Doing well except when….?
– Do you feel in control…even with the stress?
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Determine Level of Confidence
to Lose Weight
♥ Assess Johnnie’s confidence to begin weight loss.
• “On a scale of 0-10 with 10 being most confident, how
confident are you that you can lose weight?”
This clinical tool can be
used to evaluate patient
coping mechanisms and
confidence in ability to
change.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Begin the Process:
Assess Level of Knowledge
– What does she really know about her food intake
and habits?
– Does she really know how food and weight effects
health and why?
– Determine literacy level and present appropriate
educational materials.
– Develop a method to evaluate learning, feedback
loop.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Assess Current Habits
♥ Dietary
�Determine level of knowledge about food
�Assess current eating patterns using food
records and food frequency tools
�Determine changes she is willing to make?
♥Weight
�Determine her weight history
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Set Goals
♥ Diet
�Develop small incremental goals based on food changes
♥Weight
�Develop small incremental weight goals
Setting Weight Loss Goals:
The S.M.A.R.T. Principle
♥ Specific: “I want to lose 2 lbs by week 2”
♥Measurable: State the goal with a way to measure it,
e.g., 2 pounds or reduce caloric intake to 1200
calories per day and record on a daily log.
♥ Adjustable: Adjust goals as needed.
♥ Realistic: Begin weight loss at the patient’s level and
set goals accordingly.
♥ Time-based: Small incremental timeframes.
Adapted from: Quinn E. Motivation and goal-setting for exercise. How to stick with your fitness program.,http://sportsmedicine.about.com/od/sportspsychology/a/motivation.htm Accessed Feb. 4, 2009.
Forms Guide:
Written Self-
Contract
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Dietary Goals
♥ DASH Diet: Consume a diet rich in fruits, vegetables, grains and grain products,and low fat dairy products with a reduced content of saturated and total fat.
♥ Dietary Sodium Restriction:
no more than 100 mmol = 2.4 grams sodium or
6 grams sodium chloride.
♥ Weight Reduction = decrease caloric intake to lose 2 pounds per week.
The DASH Eating Plan can be accessed at Website:
www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.html
Forms Guide:
Dietary Recall
Helps to evaluate
eating patterns as well
as estimate total
calories, % of calories
from fat and sodium.
Forms Guide:
Nutrition
Teaching Tools
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Summary
♥ Mindset is a beginning framework for behavior change.
♥ The PCNA Forms Guide is a wonderful adjunct to patient
education and aids the health care professional facilitate
patient care.
♥ The forms used in this presentation are a few of the many
that are in the Forms Guide.
♥ The Forms Guide can be accessed online at www.pcna.net,
downloaded to your computer, and personalized for your
practice.
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Diane Quagliani, RD, MBA
Quagliani Communications, Inc.
MINDSET A New Strategy for Health Behavior Change
Use the chat box located on the left side of your screen to ask a question.
What might you do differently now with your patients?
Questions?
Carol S. Dweck, PhD
Stanford University
Lola Coke, PhD, APRN-BC, CNS
Rush University College of Nursing
Guest
Speaker
Guest Speaker Moderator
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Thank you to our sponsor!
The Coca-Cola Company
The Beverage Institute For Health & Wellness
This activity is presented by the Preventive Cardiovascular Nurses Association (PCNA) and sponsored by the Beverage Institute for Health & Wellness
Copyright © 2009 by the Preventive Cardiovascular Nurses Association
Nursing and Dietetic Professionals:
To Access to the Course Evaluation and Obtain a CPE
Certificate*
Click on this ICON on the lower right side of your screen before exiting this
program to access the Course Evaluation and Obtain a CPE Certificate.*
The CPE LINK will also be provided in a follow-up email to all participants.
*This program is pre-approved for nursing and dietetic professional CPE.
Other professionals may obtain a Certificate of Attendance
by emailing [email protected] or calling 1-800-274-9390.