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We got an entrance. Good evening, everyone. And welcome to this evening's learn with nurses session. Um, Happy New Year. I don't think we've seen you that yet this year. This is one of our learn with nurses come in conversation sessions, which is where we invite some fabulous speakers from around the country. Um, also known as bringing some of our best mates in for a chat about some topics that we're really interested in and we think you would be to. And part of that is around seeing what else is available and giving you a bit of a taster of things that you could tap into on another occasion. So if I've not met you before, I'm I'm Joanne Halls. I'm the clinical director for Learn with Nurses. And I'd like to extend a very, very warm welcome to all of you joining this this evening. Lovely to see so many of you already saying hello. And I can see Lindsay. You're just down the road from me. I'm I'm in Norfolk to I'm in North Norfolk. But I thought I recognized your name. And Sarah from Cambridge. You're you are already know what sort of a tree everyone's in for. So it's great to have you all along with us. So, um, you've navigated your way into medal. Um, and I know that some of you will have participated in lonely know successions before and know all about what happens. But towards the end, I'm gonna drop in a link for feedback which ask you to click on that and give us the feedback for this session. We really do appreciate your feedback. It helps us guide and think about what content that we want to do in the future. It's also your key to getting your certificate. So when when you fill in your evaluation, if you be sure to make sure that you you've got details on their your names and things to make sure, um, that you're certificates in the right name and there's also an opportunity to select catch up content. Although this webinar all of our in conversation series, are recorded and will be available on demand a little bit later on. So we can't see you. You can I see the royal meat. We There's only me here at the minute and the little cuddly dog that you can see behind me. Um, but if you don't know this, we can't see you. We can't hear you. So anything that you want to communicate with us, we'll need to go in the chat, and that will be seen by anybody. But if you're, you know, making yourself a cup of tea, having a glass of wine, brushing the dog, cutting your toenails, whatever you're doing, that's absolutely fine. You won't disturb any of us, so Well, I'd hoped we were going to be joined by Jan and Ali. All I can see is a blank all at the minute. But I'm sure they're going to join us shortly. And you know, I've been absolutely itching to get these ladies along to come and have a chat with us, because I have the well, I've known Jan for years anyway, and have the pleasure of joining them on motivational interviewing study day recently. And honestly, get yourself a cup of tea if you haven't already got one. This is just gonna be like watching something really cool on telly with the difference that you can actually put a question in and chat to the stars of the show whilst we're going So, uh, sit back. Relax. Enjoy the fly and gel. And Ali, are you There we are. Hello. Hello, everybody. Lovely. Lovely to meet you. Even though we can't see you. And I know we've met some of you before because we've been reading with Sarah. What? We're going to teach you love. You've been. But anyway, it is lovely to see you. There's always an elephant in the room when it comes to communication, a communication studies and learning about communication. There's always an elephant in the room. So let's call it out. What are you doing? Why? Why are you in the room? What is the elephant? Yeah, doing? It's about time, isn't it? We've never got enough time. I'm busy. I'm a very, very busy professional. I've got time for this motivational interviewing rubbish I've got I've got to tell people I've got to fix them. I've got to advise them. I've got to sort them out so often. The elephant in the room, isn't it? I don't have time for all this. I'm a very busy person. Never mind me being an elephant. What are you doing in a superhero outfit? Uh huh. Okay. I want to save people. I want to make a difference. I want to have compassion. I am a nurse, healthcare professional, and I want to make a difference. Wow. Okay, we'll have you got a way of doing that without it taking much time. Funnily enough, I have. Actually, with whatever time you've got, I can tell you how to make it more effective. Okay. Yeah. All right. I'm interested to take your head. Turn your head off. I'm interested. Should we tell them who we are? Yeah. Go on, then. Do you want to start gone then? So I'm John Proctor. King. I would normally say give me a wave if I've met you before. Uh, if you're waving Hello. I am quite old now. I've been a nurse for 42 years and I love my job. I do Mostly. Yeah, I do. I'm really happy. Um, I do mostly training now. I train a lot on vascular disease on Friday. I'm doing half, uh, strokes and af next week. I'm doing a basic CVD course I do, uh, from the studio with various gps that I work with. Some of them are famous from GPS behind closed doors um I do a lot of training now. What? Between you and me, if I'm really honest, I know shed loads. I've probably forgotten more than ever know. I know shed loads, and I do vascular craft. Karzai have orbit on it. The new thing and Chad's vask and or all sorts of stuff. I know. But the thing that makes a difference when I'm with somebody for one sentence for a whole minute who or even maybe 15 minutes once a year while I stabbed and squeeze a measuring typing are the skills of motivational interviewing. They have returned my joy. Or they save my joy and my curiosity about people. Because what attracts people to this kind of role? Whatever you roll, I know you're all in healthcare and Jo Ann's waving. Thank you Know, um, what attracts you is that you care. You want to make a difference, and you like people So motivational in June for everything that I know about neurons, about flows in about all sorts of stuff. This is the thing that enables me to be more effective. So I'm really happy to be here to I'm hoping to light your flame for this to light a fire in here. That makes you think, Actually, I might be something in this. I'm going to find out more. Who are you? Thank you. I'm just saying hello to Allyson. I've got nice Hello from Allison. Oh, that I have to put my glasses on. So my name is Alison Old? Um, I'm a clinical psychologist by trade and work. The NHS for about 15 years. Specialized in working with Children. You know, people, Uh, and I started using it about 25 years ago. Now, I know we've got some people from Newcastle on the line here at Southtown Side District Hospital. If that rings any bells with anybody and as part of the pediatric diabetes team there. And after one too many frustrating Friday morning and one too many Friday morning, frustrating clinics where we're just really frustrated that we weren't being as impact for we weren't making the difference. We wanted. We I went away and learn about motivation interview, and we started using it as a multidisciplinary team. It fundamentally changed what we did. The conversations we have, particularly with adolescents, with families, parents, and I've been using it ever since um, use that senior manager in higher education sector. So you know all of you who manages out there. I know there'll be a lot of you when one of your members of staff goes cooking mystery and says, Oh, I've got that problem with you. Tell me what to do. And you go, Yeah, yeah. And you tell them what to do, and then they go and they don't do it. And then they come back and ask you what to do. And they go away and they don't do it. Started using motivational interviewing in that scenario as well. And again really, really hopeful. So I use it in therapy. I use it with my kids. Use it with my partner. Don't tell that, uh, and of course, you know, we train on It is fabulous way. It's really a kind of corner stone communications. So that's what I do. I'm self employed. I do mental health training as well, for it'll So, um, and just again really enjoy my job. Get to dress up a lot. What's not to love? Somebody working at N T G. H. Very pleased to meet you. Yeah. So that's who we are That's us. And you kindly introduce yourself if you come in And we know we've got a really, really mixture of people. And we cannot teach you to do motivational interviewing today. Okay? We can't do it. Uh, what we can do is try and explain it So you may be more curious and seek it out to learn more about it. It is now one of the fundamental things for the NHS. Is this personalization of care? You may have heard that sound bite The personalization of can see my fringes personalization of care. And it's all about changing the whole emphasis from I will fix you poorly. Person. I am an expert. You are in expert. Come to the hospital. Come to the doctor, come to the nurse, come to the NHS. We will fix you. Run along. Amended to a lot of what ails people. Now we can't fix it is what they do when they're not with us. It's about changing the whole culture into equal and respect. Uh, what's the word? I'm respectful. Respectful not. I know. I'm expert. You're an expert, But to experts in the room now, I would be really curious to find out for you to type in. What are the things in your job that you think? If I have to tell them to do that again, I am going to poke my own eyes out. I'm good. Might as well beat my head If they just do What things might those be? Just type them in. Give us a flavor. Oh, Al is being a leaflet have ago. Type them in. What are the What is the health advice? The health promotion, the clinical advice that you give to people You think they just do it exercises after seeing a physio physio is doing their exercises. Yeah Stop smoking. Lose weight. Move more Take medication, Doctor Information? Yes. Oh yes. She Sheila You keep using your inhaler even if you feel well. Oh, Pierre, Stop smoking. Sally, stop smoking diet and lifestyle Exercise. Yeah Jackie, take this Inhaler is a big theme. Take your inhaler. Reduce alcohol consumption. Oh, yes. Stephanie, attend your screening appointments. Just attend them. Will you just turn up for them? So these are the kind of things where you might wonder why I've got a leaflet on my head that we can become a bit of a living leaflet about where we say the same things again and again and again that we get a bit of professional patter. Really? Yeah. And am I can save you a bit from professional patter. Can't Do you recognize professional pattern? How does it sound? Well, what I need you to do is I need you to take your inhaler more. I need you to take it regularly. Even if you're not getting any of those symptoms. It's really important that you take it regularly because it's a preventative medication. Okay, It's not You're not supposed to take it. Reactively supposed to take it preventatively. The more you can do to take it regularly, then I want to smack her in the face. Now she's getting up my nose. She's telling me what to do. That has been quite nice. Yeah. You develop a patter and it falls out of your face. Do you ever find yourself? Just think from it. Do you ever Do you ever think you have? I said that already and if ever you get that feeling Oh, I said that. I think I've said that I've ticked all the boxes you may have become a living leaflet. I was one for years. Let's let's be honest. I was one for years we've got Thank you, John. Does anyone recognize? Yes, We're getting a Yes, that's me. What you need to do is you need to have, uh, five portions of fruit and Veg day doing it. You just It all comes out. Remember to take do your exercises three times a day. Why don't you do that? You just developed this pattern and they don't do it. Do they have have you all worked out that telling people what to do doesn't work? Yeah, have you? Because if anyone thinks they have, they must be very new in their job. If they think they might get a very, very that lovely person that just really, you know, you get them at the right. Have you had Oh, getting a resounding Yes. Yes. Oh, yes. And what? You hear What you hear when people don't want to change, but they're being polite about it. Is something like this. Yeah, but the thing is, I can't remember my inhaler all the time. I know. I know it would be good, but the singing my life's a bitch. A work shift. I can't always remember to have it at the time, you know. But you need to do. I'll prescribe you an extra one. Put one in your handbag. So you've got one. Whether you're at work or whether your work. I don't have my handbag with me. That's the thing, you see. Okay, Well, you can you can put in your pocket. Yeah. We can't really set yourself an alarm. That will hope you tell. That doesn't matter. Well, I just turn it off because it does my head in. I'm working harder and harder and harder. Try and get to do it. And what you get is, yes, but yes, but And Joanne, you're absolutely right. Aren't we trained to do that? Tell people yes. We are absolutely trained. It's drilled into us. Tell people what to do. But the problem is, it doesn't work. Yeah, even Mex says Ask. Advise Axion. And we've discovered that advice. Just get some people's nose on a full motivational interview day from interviewing day. What we show you is how to take advice. Everything you know, skills, experience, knowledge, guidelines, principles that all the exercises you know, the benefits of exercise, the reasons for all of that. But what we do is we don't go like that with it. We lay it out and we work with the person's brain more effectively because advice is irritating and we turn it into information, which is empowering advice, being irritating. We made that up. But Darwin said, information is powerful and that's what we show you how to do. Yeah, and it's about the way what we're talking about here is a way of presenting things. So it's the language you use. It's how you lay it out. And it's how you do that without pressing somebody's buttons or causing threat to them. Really? Um, So if we go back, let me ask you, John, what is it about our brains? That means that motivational interviewing works when telling people what to do. Doesn't we are fundamentally wired to resist persuasion? Persuasion? You must. You should. You need to. You've got when we are being persuaded. What happens is it's the same impact as a sabertooth tiger. It's a threat. It is seen as a threat. Okay, So if I was now to say to you, what you've got to do because it's affecting the power of the, uh, training and the software near your phone near your computer. I need you unless you're on it to take your phone and put it in the other room. Just leave your phone in the other room. Don't bring it in with you. Put it on silent and put it in the other room. Most of you would think No, I don't think so, really, even if it's really quick, even if it's really quick, you think, Oh, I don't want to do that. If we were to tell you, you've got to a walk, you've got to do 30 minutes exercise today. You really must. It's very, very important all the things you do today. But if you'll go, no. And it's about on a day we explain the whole brain thing, But it's about when we give advice. We create this dynamic dominance, dominance. I actually know what's best for you and above you in the pack. I am dominant or this is a threat. There is an expect. I expect you to do this now. Our reasonable brain gets the message from our caveman brain danger threats. Somebody's telling you what to do. And we don't like it. Apparently, it's not that. What have you heard of people being resistant? Well, they're not. We create it when we tell them what to do. Just typing. Do you like being told what to do? Anybody? Our love it has anybody like being told yes or no? Anybody done exactly the opposite of what they've been told to do? Because they've been told to do it. I saw something on Facebook recently. It was a school. Uh, it was in a museum, and it said What happens in the museum when you're told it's a non touch thing. And it was somebody with their finger through the nose. It was brilliant. Yeah. And you guys, thank you very much. No, no, no, no, they don't. No, not really. Not really. I'm only called Proctor King. I've only double barrel because I was told I couldn't What? I prefer I sister on a And do you remember? You were You were working for a charity or something and they decided they were going to do the Great North a bike ride and you didn't even know what it was when they were talking about it. No, I did it. I joined in. She didn't write a bike. She didn't have a bike. No, I joined in, but nobody told me I had to have volunteered. But you didn't know what it was. No. And you came home and said said, You can't do that. Yeah, I would do the opposite. Sends Lindsey. My teenage daughter just shouted, No, well done. Tell her Good for her. She's got a positive cave woman in there, and that is inherent. It's not our the conscious, thinking, clever part of our brain that does that. It's the, uh, it's without thought. It's without conscious thought. It just happens, and it's part of our cave person protecting us. And so what motivation interviewing does is it works in a different way with a person. But if somebody said it's about teamwork, equal power collaboration, you're absolutely right. That doesn't do that dominance, and therefore, let's it up to our clever executive thinking part of the brain that makes decisions and think strings through now isn't a magic cure. It's not, you know, but it is well, you tell them. Is there any evidence for it. Yes, the shed loads. I'm not allowed to use rude words because there's your teenage daughter in the room. There's an awful lot of evidence. Last time I Googled evidence for motivational interviewing, I got six million hits on Google, so you need to take it right down. If you look at individual behavior, change from nice motivational interviewing is in there. If you look on the personalized care agenda, motivational interviewing is in there. If you google it, you have to go right down to, like, midwifery, breastfeeding. Before you limit it a bit or stroke or physio or exercises, you have to go down to your particular bit to find it. And the bottom line is the guy that invented it or he didn't really collected the skills together and gave them a name. Steve Rolnick, he says. Can we stop wondering if it works? It does. Can we just use it now? The lovely thing about it is you can't do any harm. That's you can get it all wrong, all of it completely wrong, and all you're doing is what you normally did, and you can try a little bit just a little bit. You can start using a bit called as share asked to share information or or or just ask one open question and listen for the change talk and think, Oh, well, I don't know what to do with it now, but that was interesting and you can't do any harm at all. It's not a therapy. It's it's You don't have to be declared fit to use it. You can give it a whirl. They it is intrinsic in all our jobs. When you learn about it, what you learn is you waste an awful lot of time telling people what to do, and they don't do it, and we do it more insistent in different styles. But this way, one of the things that I just love about it is that it makes life easier. It is a way of for once you go on a study day or you learn about something that makes life easier and makes you feel better. We we trained all the midwives in pool. The evidence is out there as well, but we trained all the midwives in pool, and they used to use quite scary methods for scaring mother's into stopping smoking and They started using motivational interviewing, and they won an award for their smoking cessation success and what they noticed. Well, what the the area midwife noticed was they seemed a bit happier and they seemed a bit like the stuff. The staff. Well, I Yeah, well, I mean, this this is good. So they did, um, a kind of a an evaluation of how they were feeling. And they published an article in practical midwife that said, basically, not only were they more effective, they felt better. I felt less burnt out and exhausted and as if they were constantly getting out people, it was for their mental health. It's for once you learn something that makes life easier and makes you feel better. And you can't kill anyone if you get it wrong. And I think there's something really keen there. Well, there is something really keen. They're about responsibility because, you know, John alluded to earlier we we we choose the kind of professions that we're in because we're lovely people who care about people who want to make a difference who want to be effective. But one of the things that that can do is it means that we take responsibility for changing the world and every patient that we see. We desperately want things to be better for them, and that's a lot to take home at night. And motivational interviewing isn't shirking that responsibility at all. It's, but it's 80% more likely to bring about change the normal behavioral, uh, kind of interventions. And so it does it in a different way that is more effective, but that enables the person to take responsibility for what they need to change because they're not going to change it. If they've got the responsibility and you're facilitating that you're not making it happen, you're not doing it for them. You're facilitating and enabling them to get to where they want to be and bring about that change. So should we do you a demonstration? Let's ask them warm. What do you want us to do? I mean, it'll be a caricature kind of thing, but, um what topic? Give us A. We'll do it without a lifestyle Health style topic. What? What kind of thing would you like us to see? Let's do it. I have a feeling, uh, we've got exercise exercise. What else? We wondered about doing exercise because it's very generic. One for a lot of people. Yeah. Polypharmacy. Oh, lifestyle diet. Starting new meds might be using more. I share us for that. Potentially. Yeah. Okay, so we've got a bit of a thread of exercise because it's in lifestyles. You got in early with your exercise, and it's probably vanilla enough for everybody to see that. So and ask. Share. Ask Stephanie. Have you done? Have you done motivational interviewing training before you put your ass share? Ask because we're fairly limited in what we can do. Fluid intake and to these are all our favorite topics. We love this. Um, okay. I suggest we do an exercise because it's generic enough. Right? Okay. So am I. You have at uni, right? I bet they use slides and everything, didn't they? Do you want me to do you? Do you want to do Who's who? Uh, I I'll talk to you. Should I talk to you about exercise because you're aiming to do that? All right. You can be a bit of a caricature if you like. So without motivation, without without possibly a little bit caricature, But probably not that much. Um, So, Ali, we've been through your medication. I've done your BP. Okay, Uh, I've covered you that you need to increase your exercise, love. Yeah, because the thing is, I'm not asking you to run a marathon. What I'm saying is you need regular exercise. It has so many benefits. It's good for your blood sugar. It's good for your BP. Good for your weight. And you're wanting to get your weight down. So come on. I just I'm not sure what I do that's out there. I'm just I'm not a gym bunny. Uh, I would go walking, but the weather's awful. You know, I know what you're saying, but it's just busy. Work's are tight, you know, By the time I finish work, it's dark. There's no way that what do you do at lunchtime at work? Because you don't get out. Sometimes I go get lunch. If I do get lunch, I'm really lucky. But it's just to grab a sandwich. It's not enough time to Well, you could always grab a sandwich and walk out, and it's about knitting it into your every day. Okay, You don't have to go to the gym and you always have meetings over lunchtime because, you know, practice. That's the only time you're going to end up diabetic. At this rate, you know that you're prediabetic now and this is a combination of diet and lifestyle, and lifestyle means doing more. I mean, I do Always dancing is good. You can do that in your own front room. I don't really like dancing. No, no, no. So I would do walking. But, you know, I think I need to wait till the weather's better. Perhaps I'll start it in the summer. Well, there's never any time to start like now, because lunchtime, it's good to get out, gives you a break from you. But we have meetings at lunchtime and stuff. That's when the practice has meetings. You know, they shut it down for an hour. Well, I think you really need to try something. I've got an awful lot of leaflets here for you, and what you can do is you can sign up for things. There's a lot of things free, and there's a website. You really need to get some exercise, Okay? Even going up and down the stairs or getting off the bus to stop. Okay. Okay. Okay. All right. Yeah, a little bit insistent. Who did all that? Most of the talking. Who is working harder and harder and harder to try and get me to do it. Who was getting more and more cross irritated? Throw the leaf it away? Yeah. So what we'll do is we'll use motivation interviewing, okay? And see how it goes. Yeah, So common, isn't it? It's like, uh, it's like, Yeah. So here we go. Motivational interviewing. Um, right, Al, we've We've come to the end of your consultation, and we've got a three or four minutes left. We we had covered your weight and your results and everything. Uh, and exercise was left to be discussed. So what you're thinking Well, I know you're going to want me to do more exercise. And I know it's part of the being healthier and being fitter, but if I'm honest, I just don't like it. I don't like going to the gym. I've never been a gym bunny. I haven't got time. My life's really busy. I've got a lot on. So it's not sounding like it floats your boat. You're busy. But you realize that it's going to be mentioned because you recognize it's really important. Well, you know, I know that the guidance says exercise is good for you. I know we're supposed to. And you know, obviously I don't want to be diabetic, but I just I've never liked it. I just don't like it. It's just it doesn't float my boat. Your Yeah. Oh, dear. So it doesn't float your boat, and you don't like it, but you've actually been reading the guidance, and you recognize that the connection with physical activity and the increase of chances of diabetes and the fact that everybody is hoping that you will be able to do more. Yeah. I mean, I didn't read the guidance. If I'm honest, it's just you like you bang on about it every time I see you. Uh, and it's everywhere, isn't it? You know, do more move more just is everywhere. Uh, you know, my partner, they give me all the time about it. They're really into exercise. Actually, I do lots more than I do, and, uh, she just she wants me to do it more as well, but it just you know, it's finding something. You enjoy, isn't it? Right? So she's really keen. She wants you to join in. It sounds like she worries about your health. And it's the finding the thing that you'd enjoy, she does worry about my health. Yeah, Yeah. I mean, she wants me to lose a bit of weight and get a bit fit to be doing a bit more. You know, nobody wants to to be diabetic. It's really scary. Thought so. Yeah, but, you know, it is just about finding what you want. So it's that finding the right thing and I suppose the time to do it as well and carving out that time. Really? Yeah. If you Well, what thoughts have you had about something you might enjoy? Well, I mean, I do. I do enjoy walking. I don't classify that as exercise. So you know, me and my partner, we go out for nice walks in the summer, and, you know, it's absolutely beautiful. Some of the some of the scenery around are some countries. It's lovely, we're spoiled. But you know, when the weather is dark and you know it's just not got the same attraction. I have to be honest. And it's cold and it's rainy. Um, but certainly I do. I definitely do more in the summer. Um, and I enjoy that, but I haven't got an equivalent for the winter, if you like. So in the summer, your face Little When you mentioned your summer walks, it did your face little, you're outside. You feel good. You do use summer walks, and it's about finding something that could float. Float your boat? Yeah, in the winter. I mean, one of the things I mean, obviously one of the things that I enjoy in the summer is is the countryside. But the other thing I enjoyed just spending some time with my partner because you don't often get, you know, time carved out where you're just having a chat and catching up and stuff. If I could find something where that we could do together where we get that quality time, If you like that, that would make it worth my while. I think you know, because you don't realize you're exercising them right? So when you're chattering, you don't realize you're exercising because if you enjoy it, it's carved out time in the summer, you go walking and she really wants you. She really wants you to stay fit. Obviously loves you. Worries about you. Doesn't want you diabetic once you fit. She does? Yeah. She wants me to look after myself. I mean, she do whatever. I kind of came up, but she do with acres, you know? She wants me to look after myself. So if I said to her, Look, I want to go dancing with dolphin, she'd be well up for, right? I haven't seen that class now. No. Do you, Uh, what do you know about what's available in the area? Uh, well, I just know about the local leisure center, Really? But there's no way I'm going swimming, you know, I just, uh, and that's the main. I don't know what else they do that on there, but swimming is definitely out the occasion occasion. I don't, but anyway, yeah, Would it be all right if I tell you about some other stuff that's available? Yeah. So what's available? Leaflet? What's available in the area is X y Z that's available. These things are low cost or minimal cost. Um, and there's dancing with dolphins swimming with your head in there. Um uh, jumping in the air, throwing yourself around all sorts of classes. Yeah, anything. What you're thinking. Well, you know what I think? What I need to do is I think I'm going to take Is it okay if I take that information? Yeah. And I think I'll have a chat with my partner about it and see what she's got to say. Some of those look okay, but I definitely don't want to do it on my own. So I want to do it with one that, you know, we'll fit in with Dawson and is okay? Yeah, in terms of kind of the timings and things, but I can see Yeah, yeah. If I could get into the routine. I mean, it doesn't have to be every day, does it? It's just once, maybe twice a week. If I can get into the routine and it means I'm getting to spend some time with that would be a really nice byproduct of that. So you know your stuff. You know, that is good for you. In the summer, you go out and you enjoy the fresh air, and you actually enjoy the time to talk with your other heart and you're thinking. What? What could replace that? That isn't That is not out in the out in the cold because you enjoy time with She wants you to be fit. She's offering you lots of opportunities. Should do anything you wanted because clearly she cares a lot. And you know what? If we're doing something down the leisure center or wherever it is for an hour means that I'm not eating or drinking wine in that hour. So it's a bit of a double winner. Really? Double whammy. Yeah, well, I will leave that one with you. It sounds like you've got a bit of a plum brewing. Yeah, I'm gonna have a good think on that. Thanks for all your advice. You know, it's a pleasure. It's a pleasure. So we got some great reflections in here. Can I just Can I just reflect on some of what people are saying? So I'm just gonna because there's some brilliant stuff in here. Yes. So somebody's got questions. So somebody saying, reflecting, summarizing, affirming, Yeah. Three key skills of motivational interviewing that we go through the day. And there's lots and lots and lots of that happened. And you also Joanne said, allowed the patient to do most of the talking. Yeah, emphasis on position, patient decision making rather than being told what to do. Absolutely, uh, and then highlight the importance of a supportive network. Uh, somebody else said conflicts. Yeah, And at the heart of motivational interviewing, what you are doing is you are working with somebody's ambivalence and that ambivalences shall I shan't I will. I won't I They're conflicted, you know, if we weren't conflicted, would have changed. Anyway. It's the fact that we're in. Two minds were ambivalent. That means that we haven't changed, that there's pros and cons and that what you're doing within motivational interview is you are working with a person's ambivalence with their shall they sh aren't they? And that's what you heard, uh, Jan doing but what she did really nicely there was. She found out what was important to me. What was the meaning of things for me So caring partner, wanting to spend time what the what the drivers for me And the thing is, you have to be collaborative to do that because John is not an expert in me jeans, an expert in her stuff, but there's only me. That's an expert in me. So she's only going to find that out by having a collaborative, equal part conversation with me. And I'll always be the expert in me. We've We've got a few a few questions allows the patient to be included. Total different response. Nice reflection. Um, we've got, uh, wondering whether, um, I can be used when making quality improvement changes in the team. Absolutely, Totally. We often teach all chief execs senior leaders. This is a management skill. My other half was one of the very senior managers in the NHS, and he used it all the time. It's not for everything. It's not for everything. It's not for clinical decision making. It's not. If someone doesn't have capacity, it's not for safeguarding. It's for those conversations where you will leave them and it's up to them to do it. They will leave you, and it's up to them to do it so that stuff that you can't it's not when you roll to the pretty one and clean them up or hold the hand while they're dying or you put the right. It's for those conversations where you're not responsible for it. It's not for you to decide. Um, if you're working with someone who doesn't really engage or is that what is just yeah, somebody who doesn't really engage or isn't insightful. So one of the first things that I would do with somebody is in whatever time you have left, make sure that you talk about what they want to talk about within healthcare. So if you're running a diabetes clinic, I'll be saying, you know, you've done all the stuff that you need to do. And I'd be saying, You know, when you came in the door today, what was the most important thing for you to get out today? What do you really want to talk about? Uh, within the diabetes clinic? I'm just using it as an example. The kind of things we talk about is, uh, taking your insulin dire lifestyle, smoking alcohol. Which of those is it most important for you to talk about today? So you're talking about which whatever it is you talk about that you're getting, you're working collaboratively with the patient to get an agenda. So what that means is you're working in an area that they're more likely to be motivated for, which means they're more likely to be engaged and to have some insight if fundamentally, they don't want to be there and they don't want to be talking about anything like this. So how are you getting on with everything? Oh, it's all fine. Yeah. Okay, so tell me a bit more about that. Oh, yeah, yeah. No, it's just It's all okay. Everything's fine. It sounds as if you don't really want to talk about it. I don't really want to talk about Honestly, I've got so much going on, I just literally I just wanted to come have you take my blood's know what my HBA c is or whatever. Blah, blah, blah, blah. And then get on my way of just you're a bit overwhelmed. Yeah, I just haven't got the space for it today. If I'm honest, you've turned up though you've had your tests, you've got your results. So you care about it. But at the moment, it's just not for you to talk. I do. And you know, I know I need a proper conversation with you about it, but I just My head's not in it today, OK? So when the time is right for you. You'll have a proper conversation. Yeah, you've turned up. Thank you for turning up you. You clearly care. And you know where you are with this. So I'll look forward to speaking to you when your head's in the right place. And I'm more likely to come back and talk to her when I am in the right place than somebody who's told me what to do and lectured me despite the fact that I don't want to be there. So she heard me. She It's not a it's not a magic pill. It won't make me change if I'm just not in that place. But if I'm 10% towards change, it might move me to 2030 40 80% more likely than traditional behavioral change methods. So we've got a lovely one. How do you cope with the pressure to collect data? Tick cloth boxes. Right. As a bridge on practitioners. Quoth. Oh, yeah. Tick, tick, tick, tick, tick, tick, tick. So what I do is I say hi. I'm John Proctor King. I'm one of the practice nurses. Thank you for coming. If you sit down, I'm always clear about time. We've got 15 minutes together today because they're times as precious as mine. So they know what they're going to share. And the plan. And this is where I usually turn around. Touch their arms at the plan, is taking your BP. I usually do it twice because I'm like that. I always say that because if I do do it twice, they don't think there's something wrong. If I'm going to leave it, well, do your BP do it twice, get you on the dreaded scales and ask you loads of questions. If it's okay with you, I'll be looking at this computer and we'll fill it in. OK, feel that this is your We'll fill it in. I'll check that. I've got it right. Okay. And with whatever time we've got left, we'll have a conversation about you and your BP or you and your diabetes. Is that okay? Yeah, and they always go. Yes, love, Yes, but I am honest and open. Always be honest. Just say I've got 10 minutes and I've got a million things to do and you might not always have time. The truth is, you might not, but even in a flu clinic where they come stood up with the sleeve unrolled do 1000 in the morning. I used to say is that we're going. I'd say thank you. What you're going to do to look after yourself till I see you next time and they go Oh, love got a list? I'd say, Well, as they're going to, I'll leave that one with you. Yeah, or love. Lovely questions. And this is where there isn't a script and you will get your own style. And I'm in a city Bradford and people are just dead, ordinary and lovely. Uh, one of my favorite questions after I stabbed and squeeze them is I say, right, Well, listen, what advice we're expecting to get from me today, and then they say, Well, you're gonna tell me to do this. I should have done that. Well, I've got to do that. Well, I have done this, and I have done that, and I would say 80% if not more of the time they know everything. Absolutely no. Everything. They tell me, uh, the amount of times I go well, you know your stuff. Do you want my outfit? I said, Well, right, then. So what's your plan? And they go. Well, uh, I said, we'll get you unit and what it is it enables you to find the joy in people. Because people are amazing when you shut up and allow them to think. And you don't treat them like that and you go get you. Oh, is he going to do that? Tell what is that gonna feel then? Oh, so you've got You've been thinking about this, haven't you? And they go. Well, I knew you'd estimate. Well, I'm I'm interested. Go on, tell me a bit more. So you're thinking you're going to take up netball, Get you? I bet you're competitive, and we're just It feels very natural in the moment. And it is just such a lovely way. And as they leave, they usually go. Thanks for all that advice. Love. Haven't given the money. They've heard themselves think with no judgment, no shame, no pressure. But you can give information in this equal and respectful way. Yeah, and and jeans. Not just having a meaningless conversation there. She's listening really hard for bits of change for opportunities to affirm, to reflect to bring out meaning. These are all the skills that we teach on the day. So she's been making look very simple, but that's really kind of it feels conversational, but you're just enabling people to be more likely to change because they know themselves. And you're enabling that conversation. I can see Joe. I think she's probably about to tell us that. That is time. How are you going to tell us? You know what? I actually I set myself an alarm for older period that we have because I knew that I would completely get lose myself in everything that you're saying. I'm quite happily sit here till midnight, to be honest with you. But I'm sure you've got dogs. We've got lots of other outfits. You went to the caveman? Yeah. I just didn't show you what we're missing. Yeah, this is the listening. Is they come out active listening? Because what we've what we hope we've done today is may enable you to think I'd like to feel like that with people. I'd like to be in my clinic, sending them off with their back exercises, all their exercises thinking good. Yeah. Great. And not oh, they won't do it. But do you know what? It's not your problem, but you. They are more likely to do it If you say. If you use these skills and pain management and physio, we get a lot of whole pain management teams. A lot of physio, the whole department on a day and they feel better afterwards because it's like I think if they're interested in doing our day, it's via it'll training, isn't it? Yeah. Somebody asks, How can we find you? I know where to find you, but I'll stick a flip chart up with our website. If anybody is in London, Is anyone in London? The London area? If you're in London, we are commissioned for quite a few days, so you can access it through your person. You can't. We can't register. You okay? We get commissioned by a network of trust. A hub, a charity, uh, individuality trust. Yeah, and they buy it and then we get they put people on it and we deliver it from the studio. If you are in the greater Manchester kind of northwest area, then if you find Aqua achieving advancing quality and Aqua Northwest, you can access there's and we've got one for them. I think it's the 20th of this is all about. Website, though, isn't no, it isn't No, because it all get it because people from the wrong area go to the wrong area. Um, there's a quit commissioners. You can get through to them London. But if you if you're curious, if you go to our website, which is at our training dot co dot UK, there is a message board. Send me a message. Put your phone number on, put where you work and I will contact you. And I will see if I can link you to somewhere that's delivering this day. And if if you're in a position to commission, I will, Uh uh, if you're in a position and wanted to commission the day, we do zoom days for up to 60 delegates and it is a laugh and anyone can join us. It doesn't have to be on nurses or doctors are all a real mixture is good, and we have a real laugh and we get all the four days training isn't full. Sarah's just talked about it, saying it's helped her practice, which is lovely. Thank you. Yeah. Thank you, Sarah. It is. It's just, uh yeah, it's a soft skill that makes hard things much easier. So back to Joanne. Poor Joanne. Back to Joanne. Thank you. I'm here listening. It's wonderful. Well, ladies, I can't thank you enough. You can see from the comments that are coming through. Thank. Has been wonderful. Will you come back and see us again? Of course. Alec and Ali does mental health. It's just a whole day on mental health. All based on Winnie the Pooh got outfits. Well, well, me and all each other piglets. So that would be just perfect for us. But yeah, come back and see anything that you want. We we have. We have a wonderful audience as you've seen this evening. So anything that you would be willing to come and chat to us about on another occasion, we'd absolutely love to have you. Um, we're as you know, very active on social media. So if, uh if anyone struggles to find a tell training to find Jan and Ali to be able to take some of this up and learn some more, then you can always get in touch with us. either via the website via social media. And we can hook you up to make sure that you you squeeze these ladies and get every wonderful drop of juice to, uh, don't squeeze me too hard. So thank you, everybody. Thank you for all of your participation. You'll see that I've dropped in the feedback link. So if you give us your feedback, you'll get your certificate of attendance, etcetera, etcetera. This will be available on our website on catch up so you can watch it again and enjoy it. Your leisure. Have a look and see what else we've got over offer. We'll have a load of new sessions coming up soon for the new year. And as you know, you're always welcome. And I think on that note it will be to say Thank you so, so much ladies. One last word from Allison. She's saying Alleys Day is fab. Got an elephant for the post in the post. We have a lot of soft toys. In fact, sell it. I don't know what will. I'm going to close us down, folks, but the chat will still be there and be open. Thank you very much. See you again soon. Take care lots of bye bye. Oh, is that it? Then