Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

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. Um This year this is one of our learn with nurses com 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 um about some topics that we're really interested in and we think you would be too. 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, um, I'm Joanne Hawes. 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 a, I'm in Norfolk too. I'm in North Norfolk, but I thought I recognized your name and um, Sarah from Cambridgeshire. You are already know what sort of a treat everyone's in for. So it's great to have you all along with us. So, um you've navigated your way into med all. Um And I know that some of you will have participated in loing nurses sessions before and know all about what happens. But towards the end, I'm going to 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 you fill in your evaluation, if you be sure to make sure that you've got details on your names and things to make sure that your certificates in the right name. And there's also an opportunity to select catch up content. Although this webinar, all of our own conversation series are recorded and will be available on demand a little bit later on. So we er can't see you. You can I say the Royal Me, 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 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 wall 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 had the pleasure of joining them on, um, the motivational interviewing study day recently. And honestly get yourself a cup of tea if you haven't already got one, this is just going to 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, er, sit back, relax, enjoy the fly and, um, Jan and Allie, are you there? We are. Hello. Hello, everybody. Love. 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 Sarah, what we 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 and 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? 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? Du? Ok. I want to save people. I want to make a difference. I want to have compassion. I am a nurse, a healthcare professional and I want to make a difference. Wow. Ok. Well, 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. Ok. Yeah, you all right, I'm interested. Take your head off, turn your head off. I'm interested. Should we tell them who we are? Yeah. Go on then. Do you want to start? Go on then? So I'm jam pro to King. I would normally say give me a wave if I've met you before. Um, if you're waving. Hello. Um I am quite old now. Um, I've been a nurse for 42 years and I love my job. I do most job. Yeah, I do. I'm really happy. Um, I do mostly training now. Um I train a lot on vascular disease. So on Friday, I'm doing heart attack strokes and a f next week, I'm doing a basic CV D course I do from the studio with various GPS that I work with. Some of them are famous from GPS behind closed doors. 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 I ever know. I know shed loads and I do vascular craft cars. I have Orbi on it, the new thing and chad vas and 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 wo or even maybe 15 minutes once a year while I stab and squeeze and measure and type in 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 your role, I know your role in healthcare and Joanne's waving. Thank you. Lovely. What attracts you is that you care, you want to make a difference and you like people. So motivational in for everything that I know about. Neur owns about flows ins 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 you flame for this, to light a fire in you that makes you think actually map something in this. I'm going to find out more. Who are you? I'm cute. I'm saying hello to Allison. I've got nice hello from Allison to put my glasses on. So my name is Allison Al. I'm a clinical psychologist by trade and worked for the NHS for about 15 years, specialized in working with Children and people. Er, and I started using it about 25 years ago. Now, I know we've got some people from Newcastle on the line here at South Ty Side District Hospital. If that rings any bells with anybody. And I was part of the pediatric diabetes team there. And, um, after one, too many frustrating Friday morning, what you say wasn't too many Friday morning, frustrating clinics where we just really frustrated that we weren't being as impactful. We weren't making the difference we wanted, we, I went away and learned about motivational 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, er, use it 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 street 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 away 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, start using motivational interviewing in that scenario as well. And again, really, really helpful. So I use it in therapy. I use it with my kids. I use it with my partner, don't tell her. And of course, you know, we train on it. It's a fabulous way. It's really a kind of corner stone of communication. So that's what I do. I'm self employed. I do mental health training as well for Tal. So, um and just again, really enjoy my job, get to dress up a lot. What's not to love somebody working at NTGH. Very pleased to meet you so that we are that and you kindly introduce yourself if you come in and we know we've got a real, real mixture of people and we cannot teach you to do motivational interviewing today. Ok. We can't do it. 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 bit, the personalization of care. I 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 an expert. Come to the hospital, come to the doctor, come to the nurse, come to the NHS. We will fix you run along. Mended to a lot of what ails people. Now, we can't fix it. It's what they do when they're not with us. It's about changing the whole culture into equal and, er, respect. What's the word? Respectful, respectful. Not, I know I'm expert. You're an expert, but two 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 gonna poke my own eyes out. I'm gonna, might as well beat my head if they just do what things might those be just type them in? Give us a flavor. No. Alice being a leaflet. Have a go type them in. What are the, what is the health advice, the health promotion, the clinical advice that you give to people is they just, they do it exercises after seeing a physio, physios doing their exercise. Yeah. Stop smoking, lose weight. Move more. Take medication, dietary information. Yes. Oh, yes. She Sheila, you keep using your inhaler even if you feel well. Oh, yeah. Stop smoking. Sally, stop smoking. Diet and lifestyle exercise. Yeah. Oh, Jackie. Take your, this inhaler's a big thing. Yeah. 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 rule and I can save you a bit from professional patter. Do you recognize professional patter? How does it sound? Well, what I need you to do is I need you to take your inhaler. 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, um, medication. Ok. It's not, you're not supposed to take it reactively. You're 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 for? Do, do you ever think? Oh, if I said that already and if ever you get that feeling of, 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 be honest. I was one for years and we've got, thank you, Joanne. Does anyone recognize? Yes, we're getting? Yes, that's me. What you need to do is you need to have five portions of fruit and veg a day, don't you? Just, it comes out, remember to do your exercises three times a day. Why don't you do them? 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 you might get a very, very, that lovely person that just really, you know, you get them at the. 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, 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 thing is my life's a bit. I work shift and I can't always remember to have it at the time, you know, and all 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 you're at home when I'm at work. I don't have my handbag with me. That's the thing you see. Ok. Well, you can, you can put it in your pocket. You can't really set yourself an alarm. That'll help you too. Oh, that does. Well, I just turn it off because it does my head in. I'm working harder and harder and harder to 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. Even me says, ask advise, action. And we've discovered that advice, just get up 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, Jan, 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're must assured you need to, you've got to when we are being persuaded, what happens is, it's the same impact as a se tooth tiger. It's a threat, it is seen as a threat. Ok? So if I was now to say to you what you've got to do because it's affecting the power of the 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 of all the things you do today. A bit of your go. 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. I actually know what's best for you. I'm 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 cave membrane, danger threat. Somebody telling you what to do and we don't like it. It's not that, have you heard of people being resistant? Well, they're not, we create it when we tell them what to do. Just type in. Do you like being told what to do anybody? Oh, I love it. Does anybody like being told yes or no. Anybody done exactly the opposite of what they're being told to do because they're being told to do it. I saw something on Facebook recently. It was a school and 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. No, not really. Not really. I'm only called Proctor King. I've only double bar because I was told, I couldn't, I, do you remember you were, you were working for a charity or something? And they decided they were going to do the Great North bike ride and you didn't even know what it was when they were talking about it. I did it. I joined in. She didn't, she didn't have a bike. No, I joined in. But nobody told me I had to, I volunteered. But you didn't know what it was and you came home and said you can't do that. I would do the opposite sense. Lindsay, 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, is inherent. It's not all the conscious thinking, clever part of our brain that does that. It's the, it's without thought, it's without conscious thought. It just happens and it's part of our cave person protecting us. So what motivational 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 lets it up to our clever executive thinking part of the brain that makes decisions and think strings through now it isn't a magic cure. It's not, you know, but it is. Well, you tell them. Is there any evidence for it? Yes. 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 6 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 um 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 a 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 you 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 us to share information 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, 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, um, we trained all the midwives in pool, the evidence is out there as well, but we trained all the midwives in pool. And, um, they used to use quite scary methods for scaring mothers 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 area midwife noticed was, they seemed a bit happier and they seemed a bit like the staff, the staff were like, yeah, well, this is good. So they did, um, kind of 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, felt less burnt out and exhausted. And as if they were constantly getting at 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 key there. Well, there is something really keen there about responsibility because, you know, John alluded to earlier, 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 than normal behavioral 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 ain't 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, shall we do your demonstration? Let's ask them war. What do you want us to do? I mean, it will be a caricature kind of thing. But, um, what topic give, 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, I have a feeling. Oh, 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 lifestyle diet. Starting new meds might be using more ASIO us for that potentially. Yeah. Ok. So we've got a bit of a thread of exercise because it's in lifestyle you got in early with your exercise and it's probably vanilla enough for everybody to see that. So, um, ask share. Ask Stephanie, have you done, have you done motivational interviewing training before you put your, as share? Ask because we're fairly limited in what we can do fluid intake. And these are all our favorite topics. We love this. Um OK, I suggest we do an exercise because it, it's generic enough, right? Ok. So am I you have at UNI, right? I bet they used 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. Shall I talk to you about exercise? Because you're aiming to do that, aren't you? You can be a bit of a caricature if you like. So, um, without motivation without possibly a little bit caricature, but probably not that much. Um, so Allie, we've been through your medication. I've done your BP. Ok. 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. Um, 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. Um, so come on, I just, I'm not sure what I do that's out there. I'm just, I'm not a gym buna. I would go walking but the weather's awful. You know, I know what you're saying, but it's just, I'm busy. Works hard time. You know, by the time I finish work it's dark, there's no way that, what do you do at lunch time? At work? Because I don't, sometimes I don't 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 in to your, every day. Ok. You don't have to go to the gym and you have meetings over lunch time because, you know, practice, that's the only time you got and you 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, do, do 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 I, you know, I think I need to wait until the weather's better. Perhaps I'll start it in the summer. Well, there's never any time to start, like now because lunch time it's good to get out. Gives you a break from work. Yeah. But we have meetings at lunch time 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 but you really need to get some exercise. Ok. Or even going up and down the stairs or getting off the bus to stop le, ok. All right. Love. Yeah. Little bit insistent who did all the most of the talking. He was working harder and harder and harder to try and get me to do it. It was getting more and more cross irritated to throw the leaf foot away. Yes. So, what we'll do is we'll use motivation interviewing. Ok. And see how it goes. Yeah. So common, isn't it? It's like, it's, it's like, yeah. So here we go. Motivational interviewing. Um. Right. I, we've, we've come to the end of your, um, consultation and we've got three or four minutes left. Um, we did, we had covered your weight and your results and everything and exercise was left to be discussed. So, what you 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 bully. 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 do 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. You're right. 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, you bang on about it every time I see you and it's everywhere, isn't it? You know, do more, move more. Oh, just, it is everywhere. And, 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 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. Yeah, 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. If you, what, 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 our country, it's lovely. We're spoiled. But, you know, when the weather's 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. Um, but I haven't got an equivalent for the winter if you like. So in the summer, your face lit up when you mentioned your summer walks, it did your face lit up, you're outside, you feel good, you do your summer walks and it's about finding something that could float, float your boat in the winter. I mean, one of the things, I mean, obviously one of the things that I enjoy in the summer is the countryside. But the other thing I enjoy is 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 can find something 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. Right? So, when you're chattering, you don't realize you're exercising because you enjoy it. It's carved outside. Yeah. 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 and, I mean, she'd do whatever I kind of came up with, she'd do with, 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 in that class though. No. Do you, what do you know about what's available in the area? Um, well, I just know about the local leisure center really, but there's no way I'm going swimming, you know, I just, um, and that's the main, I don't know what else they do that on there, but swimming is definitely out the occasion, um, occasion. I don't. But anyway. Yeah. Would it be alright if I tell you about some of the stuff that's available. Oh yeah, sure. Yeah, so what's available leaflet what's available in the area is XYZ that's available? These things are low cost or minimal cost and there's dancing with dolphins, swimming with your head in jumping in the air um throwing yourself around all sorts of classes. Um yeah anything what you thinking? Well, you know what I think what I need to do is I think I'm going to take, is it ok if I take that information? Yeah. Um, 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. Ok. But I definitely won't want to do it on my own. So I want to do it with one that, you know, will fit in with and he's ok in terms of kind of the timings and things. But, um, I can see. Yeah. Yeah, if I could get into the routine, I mean, it doesn't have to be every day. Just, it just once, maybe twice a week if I can get into the routine and it means I'm getting to spend some time with them. That would be a really nice byproduct of it. So, you know, your stuff, you know, that it's 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 half. And you're thinking what, what could replace that? That isn't, that is not out in, out in the cold because you enjoy time with her. She wants you to be fit. She's offering you lots of opportunities to do anything you wanted because clearly she cares a lot. And do you know what if we were 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. OK. Sounds like you've got a bit of a plan brewing. Yeah, I'm going to have a good think on that. Thanks for all your advice. Yeah, it's a pleasure. It's a pleasure. So, reflections in here, can I just can I just reflect on some of what, what people are saying? So I'm just gonna because there's some brilliant stuff in here. So somebody's got question. So somebody's saying, reflecting, summarizing, affirming three key skills of motivational interviewing that we go through on the day and there's lots and lots and lots of that. And you also, Joanne said, allow the patient to do most of the talking emphasis on patient decision making rather than being told what to do. Absolutely. And then highlight the importance of a supportive network and 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 ambivalence is, shall I shan't? I will? I won't, I, they're conflicted, you know, if we weren't conflicted we'd have changed anyway. It's the fact that we're in two minds, we're ambivalent. That means that we haven't changed that there's pros that there's cons and that what you're doing within motivational interviewing is you are working with a person's ambivalence with their, they shan't they? And that's what you heard er 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, what the drivers for me and the thing is you have to be collaborative to do that because John's not an expert in me, John's 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 power conversation with me. And I'll always be the expert in me. We, we've got a few, a couple of few questions allows the patient to be included. A total different response. Nice reflection. Um We've got um wondering whether I can be used when making quality improvement changes in a 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, just 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 health care. So, if you're running a diabetes clinic, I'd be saying, you know, you've done all the stuff that you need to do. And I'd be saying, you know, um, 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 within the diabetes clinic? I'm just using it as an example. The kind of things we talk about is taking your insulin diet, lifestyle, smoking alcohol. Which of those, is it most important for you to talk about today? So you're talking about 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 motivate 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 uh how are you getting on with everything? Oh, it's all fine. Yeah. Yeah. OK. So tell me a bit more about that. Oh, yeah. Yeah. No, it's just, it's, it, it's all OK. I, yeah, I, everything's fine. Right. 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, I literally, I just wanted to come, have you take my bloods? Know what my HBA C is or whatever, blah, blah, blah, blah. And then get on my way. I just, you're a bit overwhelmed. Yeah, I just haven't got the space for it today. If 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're 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. Er, if I'm just not in that place, but if I'm 10% towards change, it might move me to 2030 40 it's 80% more likely than traditional behavioral change. So, we've got a lovely one. How do you cope with the pressure to collect data? Tick C boxes? A oh yeah. Tick, tick, tick, tick, tick, tick tick. So, what I do is I say hi, I'm Jan Proctor King. I'm one of the practice nurses. Thank you for coming. If you sit down, I'm always clear about the time we've got 15 minutes together today because their time as precious as mine. So they know what they're going to share. Um, and the plan and this is why I usually turn around and touch the arms, 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 a while, do your BP, do it twice. Get you on the scales and ask you a loads of questions. If it's ok with you, I'll be looking at this computer and we'll fill it in. Um, ok, feel this is your, we'll fill it in, I'll check that. I've got it right. Um, ok. And with whatever time we've got left, we'll have a conversation about you and your BP. Ok? Or you and your diabetes. Is that ok? Yeah. Yeah. And they always go Oh 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 they were going, I'd say thank you. What you gonna do to look after yourself till I see you next time and they go oh love got a list. I say, well, they going down, I'll leave that one with you. Yeah. All 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. One of my favorite questions after I stabbed and squeezed them is I say, right. Well, listen, what advice were you expecting to get from me today? And then they say, well, you're going to 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, they absolutely know everything. They tell me 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, get you, you know, 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? Oh, how's that going to feel then? 00, so you've got, you've been thinking about this, haven't you? And they go, well, I knew you'd ask me. Well, I, I'm interested. Go on. Tell me a bit more. Oh, 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. You haven't given them any. 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 Jan is 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 will be making it 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 Jo, 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 the area that we have because I knew that I would completely get lose myself in everything that you're saying. I 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 for the ca Yeah. Yeah. Yeah. This is the listening ears. They come out active listening because what we've, what we hope we've done today is make, 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 all day, it's via training, isn't it? How can we find you? I know where to find you, but I'll stick a flip chat up with our website. Um, 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 p, you can't, we can't register you. Ok. We get commissioned by a network, a trust, a hub, a charity and they buy it and then we get, they put people on it and we deliver it from this studio. If you are in the Greater Manchester kind of northwest area, then if you find aqua, er, achieving, advancing quality in a north west, you can access theirs and we've got one for them. I think it's the 20th of this is our, it isn't, no, because it all get it all because people from the wrong area go to the wrong area. Um, there's a commissioners you can get through to them, London. But if you, if you're curious, if you go to our website, which is R 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 you're in a position to commission, I will, 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 all nurses or all doctors or all a real mixture is good and we have a real laugh. We get all this has just talked about it saying it's helped her practice, which is lovely. Thank you. Thank you, Sarah. It is. It's just, yeah, it's a soft skill that makes hard, things much easier. So um back to Joanne, poor Joan, back to Joan. 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. Wonderful. Will you come back and see us again? Of course, does mental health. She does a whole day on mental health all based on Winnie the pooh me and call each other piglet. So that would be just perfect for us. But yeah, come back and see anything that you want. We, we 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 er, if anyone struggles to find el, training to find Jan and Alli, 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 um you, you, you squeeze these ladies and get every wonderful drop of juice to 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, et cetera, et cetera. This will be available on our website on catch up so you can watch it again and enjoy at your leisure. Um Have a look and see what else we've got offer 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 um I think on that note it will be to say thank you so, so much ladies. Last word from Allison. She's saying Allie's Day is fab I got an in the post in the post. We have a lot of soft toys, sell it. I don't know what will I'm gonna close this down folks, but the chat will still be there and be open. Uh Thank you very much. See you again soon. Take care. Bye bye.