Helping people make healthy choices: a practice nurse shares her passion for her work assisting people make sustainable behavioural changes.

Sue Dawber is a passionate practice nurse: passionate about healthy eating and healthy lifestyles; passionate about giving people knowledge so they can make informed and realistic choices; passionate about helping people make sustainable behavioural changes; passionate about continuity of care; and passionate about diabetes education in primary care. Art these passions come together in the work she does as a diabetes nurse educator and general practice nurse at the nine-GP, nine-practice nurse Barrington Medical Centre in Christchurch.

After graduating from Christchurch Public Hospital in 1081, working in paediatrics for two years--"I thought that was my calling"--, travelling and working overseas, including two years with a maxillo-facial surgeon in South Africa, she returned to New Zealand. She worked as a practice nurse for two years and then had time off when her family was young. Dawber then returned to nursing, working as an agency nurse in hospitals and rest-homes. Twelve years ago a nurse at the Barrington Medical Centre suggested she apply for a position there. "It's the longest I've ever worked anywhere. I absolutely love it. I'm passionate about the work we art do. It is a Large practice, with a very mixed population. There's very good team work, the nurses are very supportive of each other and the GPs are supportive of what the nurses are doing. Each nurse has developed a special interest role."

Dawber's is diabetes management and prevention, and general nutrition and lifestyle. Ten years ago she identified a need for a nutrition and lifestyle clinic within the practice. "People needed education in a clinic setting and time needed to be set aside for that, rather than just opportunistic education. As a nurse, I Like to spend time with people to help them set goats and make necessary behaviour changes."

And so the first nutrition and lifestyle clinic was established. Patients either self refer or are referred by their doctors. Elevated cholesterol, hypertension and weight, if it is negatively affecting a person's health, are the most common reasons people attend the clinic. Care is tailored to a person's particular needs and situation, including what forms of exercise a person might enjoy and helping people deal with stress, using relaxation techniques. "I see my rote as trying to inspire them to find what works for them and to give them the knowledge to make healthy choices in life. There is enormous satisfaction in being part of a person's process of change and in seeing people take real pride in their achievements. There's a tot of Laughter and positivity in the clinic. We celebrate everybody's achievements."

Motivational interviewing 

One of the area she continues to upskill in is the use of motivational interviewing techniques. "As health professionals, we can unwittingly negatively influence the opportunity to help someone make change by approaching it in the wrong way. This is where using motivational interviewing techniques can make a big difference." Dawber does not focus on weight. "People have often had very negative experiences and have built up protective mechanisms around eating and weight. As they build trust with me, their confidence improves and they are more likely to maintain the behaviour change. They become confident that they can do it and that they are making the choices. It's not about a diet, where choices are imposed. Setting realistic goats is very important. I don't want to set people up to fail."

One day a week is devoted to the nutrition and lifestyle clinic. A recent development is "supermarket tours", where Dawber helps a person read and understand food tablets and helps them make healthy eating choices, including suggestions for school Lunch boxes.

A natural development from the nutrition and lifestyle clinic was actinic focusing on diabetes prevention and management. "Previously, patients diagnosed with diabetes had to go into secondary care for education and management. There was little continuity of care. I wanted to offer those patients education at a practice level, so they had a choice. GPs embraced the idea and so I set about upskilling. I also had support from diabetes nurse educator Maggie Wilson [from Pegasus Health] and the Local diabetes centre team."

Sharing knowledge

The practice is part of the large Pegasus Hearth Primary Hearth Organisation, which has its own diabetes education programme for practice nurses. Dawber assists in that education. "I really enjoy sharing my knowledge. I'm very passionate about what I do and I want to impart that passion to others. If we do diabetes education weft, we can make such a difference to a person's life. We need more practice nurses to upskill so they can offer the same fever of education to their patients, as that offered in secondary care.

"As more Type II diabetes patients are diagnosed, more diabetes education will have to be offered in the community. The more upskilled and confident we are to deriver the education, the more we have to offer our patients."

One of Dawber's primary aims in diabetes education is to instill confidence in those she sees in her weekly diabetes clinic that they can manage their condition well and make healthy choices. "Instilling that confidence is so important. The old 'eat less, exercise more' dictum hasn't worked and we have to find new ways of helping people manage their diabetes."

A self-confessed avid networker, Dawber says she gets inspired by what other diabetes nurses are doing and Loves bouncing ideas off other nurses in primary and secondary diabetes care. "Prevention is the key. I'd tore to do myself out of a job over time."

That seems unlikely. And it is highly unlikely Dawber, who is an advocate of pay parity for PHC nurses, will be moving on from her current position. "I'm staying here, very much so. I keep growing with the rote, and in general practice there is so much to learn. I never feet I know enough. Every individual's experience is different and being a part of their journey is very rewarding--it's a real privilege."