CHAPTER 12. Example of a consultation
In order to approach authenticity, neither party was prepared for this consultation, nor was there a rehearsal. Pip Mason took the role of a cardiac rehabilitation nurse and the patient, an actor, was simply asked to imagine that he had suffered from a heart attack.
This transcript is taken from a training DVD (Gilligan & Mason 2006), commentary has been added and you can watch the video clip via the website (www.elsevierhealthbehaviorchange.com). Whichever medium you start with, transcript or video, the commentary in this chapter should help to provide links between earlier chapters and clinical reality.
As you watch, you might want to ask yourself what the nurse’s options were at each point, and what would have been the likely outcome of doing something different. The foundation of skillfulness lies in the knowledge that each utterance of yours will affect what the patient says next. See what you think.
| Nurse | OK Mr. Jenkins, what this appointment is about is to help you in any way that we can to think about how you are going to go on now you’ve had the heart attack and got over it, and any changes you want to make to stop it happening again. How are you feeling at the moment? | Introduces agenda. Open question to establish rapport. |
| David | Yes, I feel, you know, still a bit shaken by the whole thing, you know what I mean. | |
| Nurse | Frightening. | Nurse is ‘logging’ his first response carefully, paying attention to the words he uses and to the way he is feeling. |
| David | Well it has come out of the blue a bit hasn’t it? I didn’t think people my age had heart attacks, you know what I mean. | |
| Nurse | No. | |
| David | Anyway, yes I am all right. | |
| Nurse | OK, so you are feeling OK in yourself, it’s just kind of being in trepidation about the whole thing. | Reflection (see p. 36) acknowledging feelings. She tries to capture his words and feelings in one utterance. The shorter the better. He used the word ‘shaken’and she used ‘trepidation’. |
| David | As I say, it’s a bit, came as a bit of a shock to me. | Elaborates as rapport builds. |
| Nurse | What do you know about the risk factors for heart disease, about what might have contributed to you having the attack? How much do you know and how much of it has been explained already? | Exchanging information as a precursor to setting the agenda. This is the first part of the ‘elicit–provide–elicit’ strategy. |
| David | Well I know it’s like stuff about, you know, with my Dad. Dad had a heart attack. He died quite young. | Begins to share what he already knows. |
| Nurse | Right. | |
| David | So, that’s something to do with it, isn’t it? | |
| Nurse | Yes, it can run in families like that, yes. | |
| David | And umm, I’ve heard like, kind of stuff about me smoking and they are going to tell me to stop smoking. And, you know, all that sort of stuff I understand all that. | |
| Nurse | Yes, smoking is one of the things. What other things do you know of? | Still exchanging information. Note that the patient has most of the information about risk factors already. The nurse merely provides supportive information as necessary. |
| David | And drink, I think drink’s part of it. Alcohol. I like a drink. I go for a drink usually every day after work, so, just sort of de-stress you know what I mean? Probably food as well isn’t it? I like a burger. Which is probably the wrong thing to say isn’t it? | The patient provides the information, not the nurse. Defensiveness starting to creep in as he anticipates the way the consultation might go. |
| Nurse | Well, basically it’s best to be honest about how it is at the moment and try to think what you want to do, if you want to do anything different. | Emphasizes his freedom of choice, even using the word ‘if’. |
| David | Yes, I suppose. | |
| Nurse | I mean, it sounds like you have got a bit of an idea of what it’s all about. Some of the risk factors you can’t do anything about. If it runs in your family, we can’t do anything about that. It maybe just means that you might want to be extra careful in some of the sorts of things that you can control. There are some things that are controllable and some things aren’t. | Still exchanging information. |
| David | Yes right, I can’t change that then. You know, if my Dad has died of a heart attack. | |
| Nurse | No, you will always carry that extra propensity to it. | Uses reflection rather than immediately jumping in to change he could make. This gives him the chance to take the discussion where he wants it to go. |
| David | Right. | |
| Nurse | But it doesn’t mean that it’s inevitable that you will keep having heart attacks at all. | Still exchanging information but now has moved the focus away from the behavior change agenda to reassurance as David is clearly very scared. |
| David | OK. | |
| Nurse | No, I don’t want you to go away with that idea that it’s inevitable. And if your Dad died young, it doesn’t mean you’re going to die young. You haven’t died of this one have you? | |
| David | No, I haven’t no, but it shook me up somewhat. | |
| Nurse | Yes. | |
| David | You know what I mean; I don’t want it to happen again. | |
| Nurse | Yes, a bit of a wake-up call. | Reflection, subtly emphasizing, by using the expression ‘wake-up call’, the fact that the fear might motivate him to think about how he is living at present. |
| David | Terrifying yes, to think someone my age can have a heart attack, it’s like — wake up one morning, that’s it, you are going to have a heart attack. Flipping heck! | If the nurse understates the feeling (a ‘bit’ of a wake-up call), patients often amplify it (‘Terrifying yes’). Usually best to understate rather than overstate. |
| Nurse | Yes. Any other factors in your life that you think might contribute? Sometimes a lot of stress… I don’t know what you do for a job, or other kinds of stresses? | Guides the conversation back to agenda-setting, perhaps prematurely. |
| David | I have got stress coming out of my ears to be honest with you. | |
| Nurse | Tell me about that. | Listening and following, moving towards exchanging information about stress. |
| David | Well, I have got my own business haven’t I, and it’s just you know, running around, on the phone, on the computer. Doing about 10 people’s jobs all at one time, you know. I am all over the area. I don’t just stay in one place. I am driving around; I am making sure that the jobs are getting done. And I am taking phone calls from suppliers and you know what suppliers are like. I’ve a building company, you know what suppliers are like, they’re a nightmare. | |
| Nurse | Yes. | When following, the less said the better. |
| David | You know what I mean. Just can’t, they promise things and it doesn’t turn up and then you have to get on the phone to them. And then it delays you on a job. And that delays you on the next job, and you’ve got people working for you lined up. It’s just that, I’m getting stressed thinking about it. | |
| Nurse | It must have been really hard for you to suddenly be taken ill then. | Expressing empathy not just with the stress of the job but also on the impact of his illness in the context of work. |
| David | It’s been a nightmare. You know, I’ve been off the last few weeks and I get back to, because there’s no one covering for me if I am not there. Nothing happens is it. Mobile phone messages with the inbox’s full, computer inbox full. Just, yes, you know how it is. | Elaborates as rapport continues to build. |
| Nurse | So, in a sense when you’re working for yourself, it’s actually really important to keep in good health. | Introduces discussion of the importance he might attach to keeping well (and therefore perhaps to behavior change). |
| David | Well yes, people relying on me as well. You know what I mean. When I am not there, nothing happening. People sit around and, I don’t know if we get paid or not. I got jobs lined up. Got knocked back and knocked back. And when it gets to summer, it’s the busiest time; it gets to the winter and if I got jobs delayed. It’s just, not good is it. So, yes I guess I have got to look after myself. | Expresses the importance, as a businessman, of keeping well (goal established). |
| Nurse | To keep your job, keep the business going. | Reflection of importance in terms of his priorities, i.e. work. |
| David | That’s it, yes. | The above reflection saved time because it summed up the patient’s dilemma. When he affirmed this, the nurse felt able to shift focus. |
| Nurse | Let’s have a look at some of the things that umm, that are possibly areas that you might want to do something about. Things that would help to prevent heart attacks. I will just kind of jot them down. The one we just talked about is work stress. | Begins to use agenda-setting chart (seeChapter 3, p. 47) |
| David | Yes. | |
| Nurse | Do you have any other sorts of stress that we need to be thinking about, that are going on for you? | |
| David | Not really. I have got kids and that, got a quite young family, you know. Demanding stuff all the time. Running around and if one of them’s not well and that, you know. It stresses me out thinking that I’m, you know if I am going to be ill and they are only little. That gets me worried. | Returns to talking about being scared. The practitioner’s challenge at this point is to stay congruent with the fear and try and focus it as part of the importance of changing lifestyle. In other words, to make a bridge between his powerful feelings and her own agenda. |
| Nurse | Yes, right, something to stay fit for. Yes. | |
| David | But other than that, you know, family stuff is good. | He accepts the move back to agenda-setting. |
| Nurse | Food, we talked about. | Continues completing chart. |
| David | Yes. | |
| Nurse | Smoking. Smoking is the number one from our point of view, but it’s not always the one that people want to start with. | Offers information on the importance of smoking but conveys that it is up to him to decide where to start. |
| David | Smoking is more important than the food and that? | Asking for information. |
| Nurse | It’s the biggest single thing you can do to benefit your health. | Gives information clearly but briefly. |
| David | Right. [Sighs] | |
| Nurse | But it’s not, not everybody finds that the easiest one to start with. | Responds to his non-verbal signs of resistance. |
| David | So… | |
| Nurse | So, tell me where you’d like to start. | This is a critical question. She keeps focus on behavior change but gives him control about the specific agenda. |
| David | Them two are connected. Stress and smoking. | Offers information about how smoking fits into his life and his priorities. |
| Nurse | Are they for you? You smoke when you’re stressed? | Follows and asks for elaboration. |
| David | I think so yes. I smoke all the time but, I think I would be even more stressed if I tried to stop smoking, you know what I mean. | |
| Nurse | Right, OK. Leave that for now. Exercise is another one. How active are you physically? | Recognizes resistance and switches to another option on the agenda-setting chart. |
| David | Well, I’ve got quite a physical job. But that’s about it. I don’t really have much time to do anything else. I’m not really the sort of person that goes down the gym. I have always thought that I was quite healthy anyway. Not healthy obviously, smoking’s not healthy, but quite fit. Just sort of naturally, but obviously I was wrong, you know what I mean? | |
| Nurse | Before you were ill, how would you have been if you were kind of running up a flight of stairs or running to catch a train? | Follows his initiative in assessing how much fitness is an issue for him. |
| David | Probably a bit below average I think. I would get out of breath I guess. Yes. I just, I used to play football and that when I was younger, but I don’t now. | |
| Nurse | It’s all kind of gone on the back burner a bit. | Reflection. |
| David | Yes, I don’t do anything now. But as I say, my job is quite physical. You know, doing people’s lofts out, a lot of stairs getting into the loft or climbing the ladders and that, it’s quite a physical job sometimes. | |
| Nurse | That sounds like, if you are getting out of breath still, it might be that it builds up your strength but not so much your stamina. | |
| David | Could be, yes. | |
| Nurse | Those would be the main things. We talked about alcohol. Alcohol is less of a risk factor for heart disease. It is actually a risk factor for other things. | Avoiding a premature focus on the exercise issue, moves back to agenda-setting chart and exchanging information. |
| David | Right. | |
| Nurse | So, I am not saying it’s a kind of good thing to do too much. | |
| David | You are not suggesting I have more alcohol and… | |
| Nurse | Absolutely not. But it’s kind of, just in terms of heart disease which we are talking about today, it’s a lesser factor. | Keeps focus on the cardiac issues. |
| David | So we won’t worry about that one for now? | |
| Nurse | What do you think if you look at all those and you put any more in that you want to put in, where would you think would be somewhere, with the life that you have got, where would be somewhere you could start to kind of look after yourself a little bit more. Keep yourself well? | She returns to the core question about where would he like to start making changes? |
| David | I guess food, I mean food’s something I could… looking at… what I normally do is, if I am working which I am pretty much, 6 sometimes 7 days a week, but generally 6 days a week. I don’t have a lunch break as such, you know. I just get one of the lads to run out to get me a burger or something. There’s a burger place just opposite where our office is, so that’s the easiest thing, get a burger or something like that. Just easy, I can eat it when I am working. Get some chips with it in there. That’s pretty much what I do. | He is more motivated to work on his food than anything else. |
| Nurse | Right, so that’s tangled up with stress as well. These are all having a knock on effect on each other aren’t they? You’re stressed at work so you don’t eat well. | Good example of how items on the agenda are often inter-related. |
| David | Well it’s all connected isn’t it? I am at work, I am getting stressed out, so busy, someone runs out, gets me a burger. Quickly eat the burger whilst I am working. | He expresses concern rather than the nurse. |
| Nurse | Yes. | |
| David | It’s just easy; don’t have to worry about it. It’s just there, on a plate for you, as it were. | |
| Nurse | It is literally, yes! So, you picked that one as being one you might be able to do something about. What… | About to enquire into importance and confidence. |
| David | I am just thinking, I don’t want to give up smoking. | Interrupts with resistance. |
| Nurse | Right, OK, fair enough. That feels like too hard at the moment. | Rolls with the resistance with a reflection. |
| David | I just think it will get me even more stressed now. The whole thing has set me back you know. It’s got me thinking about you know. Having a heart attack and that. That has stressed me out even more. And when I am stressed out, I have a smoke, because it helps me relax you know. I know it’s ridiculous but everyone says it, it’s bad for you and I know it’s bad for you. But it does, it helps me relax at the minute. Maybe that’s more for one I can think about later on. | |
| Nurse | Right, put that on the back burner for now and come back to that one. | |
| David | Yes, maybe. | |
| Nurse | The food… | Still looking to see if there is a topic he is ready to discuss. |
| David | I wish there was like a magic pill that I could take it all away, you know what I mean. | Resistance emerging again; he seems overwhelmed by the thought of so much change. |
| Nurse | I know. Yes. | Rolls with the resistance. |
| David | All these things like a bit… | |
| Nurse | It’s kind of hard, yes. If you could just take a pill every day and it would sort it all out, it would be an easy option for you. Yes. | |
| David | Do you think they’re going to invent one then? [Laughs] | Acknowledges, via joking, that he knows he’s got to look at the lifestyle issues. |
| Nurse | They might do eventually but I suspect not. Meanwhile, this is the stuff that needs looking at. If you were thinking about eating differently to benefit your heart, would there be any other benefits in eating differently for you? Or in any of these? Can you see any kind of… well thinking ‘It’s for my heart but, I would also get something else out of it’? | Loses congruence briefly, trying to keep to the agenda. Begins exploration of importance of eating differently as he seems to have chosen this as the place to start. |
| David | Well, if I tried to give myself like a proper you know, lunch break you know, just said ‘Right this is my lunch break, I am having my lunch. Phone off the hook, I am not available. I am going to have half an hour. Not going to think about work.’ I say that sitting here though but, you know what I mean. It’s easy enough to say it here. But maybe that could be part of, we could work towards that. | Sets himself a target; stop work for half an hour and have a healthy lunch. |
| Nurse | And what would you eat in that break? What would be feasible for you? You obviously need a lot of energy with the job, so you are not going to be starving yourself. Good healthy stuff. What do you know about the sorts of foods that are good for your heart? | Exchanging information about healthy eating with a view to coming up with strategies for meeting his target. |
| David | Fruit and stuff I am guessing. Is it? | Seeking information. |
| Nurse | Fruit and veg. | |
| David | Fruit and veg. | Resistance waiting in the wings here. |
| Nurse | Anything that’s not too fatty. The biggest enemy is things very greasy, things like you say, burgers, anything that’s been fried or with loads of butter on. | Providing information. |
| David | All the stuff I’ve been eating for the last 30 years. | |
| Nurse | And that’s a very common thing in your line of business. It’s classic; lots of calories and grab it quick. | Trying to convey a non-judgmental approach by talking about his eating habits as normal or commonplace. |
| David | And I guess what I should be doing is make — bring stuff from home isn’t it? Like making something in the mornings. | Now he’s got the information about healthy eating, he starts to explore strategies. |
| Nurse | Well, that would save you the time thing, because it sounds like you don’t want to go walking round trying to find a café somewhere. | Supports his ideas. |
| David | So, I don’t know. I am saying bring a salad and that, thinking — can’t just have a salad for lunch can you? Well I can’t. | Resistance emerges again once he thinks about the reality of what he’s suggesting. |
| Nurse | What about sandwiches? Is there any sort of sandwich that you could eat? | Shifts to other options rather than engaging in a debate about salad which might increase resistance. |
| David | Sandwiches are better for you, like? | Seeking information again. |
| Nurse | Depends what you put in them. | |
| David | Can’t put a burger in it? [Laughs] | |
| Nurse | Absolutely not. Burger butties, chip butties! | Responds to request for information. |
| David | Can I have cheese, is cheese all right? | Still pursuing and receptive to information. |
| Nurse | Some cheeses are much lower fat than others. | Responds with further information. |
| David | Right, low-fat cheese. | |
| Nurse | So, things like… | |
| David | That’s what my missus has. | He is considering possibilities. It seems it is important to him to change and he’s struggling to see how to make it a reality. His resistance seems to stem primarily from a lack of confidence. |
| Nurse | Low-fat cheese? | |
| David | Well, she has them spreads. I’m not really into those spread things. You know what I mean. | Back comes the resistance. He cannot picture himself doing what is being asked of him. |
| Nurse | Sounds as if you, your wife is quite conscious about low-fat food then, is she, for herself? | Reflection, drawing his attention to his wife as a potential source of information and support. |
| David | Yes, she looks after herself. Yes. | |
| Nurse | So, she knows all, she would be able to help you. | |
| David | She probably would, yes. | |
| Nurse | About thinking about all of this. | |
| David | Probably be blooming amazed. She would say, ‘What are you doing?’ | |
| Nurse | But she would be a support to you in terms of having the knowledge to… | Building confidence by exploring a source of support. |
| David | Yes, she is as worried as I am about this whole thing happening. I mean, yes. I mean, I could probably ask her to, you know, help me out. Sandwiches then is it? | Sees the possibility but is reluctant to commit. |
| Nurse | Well let’s have a think, that’s one option. Let’s think of some more options for what you can eat. Does anybody else you work with tend to take their own? | In the face of resistance, doesn’t push it. |
| David | No, I am working with… most of the lads I work with, you know, are young lads, so, yes. You know, haven’t got a care in the world have they? When I was 17, 18 I didn’t give a monkey’s what I ate you know what I mean? Whatever you want — chocolate, packet of crisps, chips to keep you going. Some of them don’t even have lunch you know what I mean, just smoke their way through lunch. All part of it, all part of the environment in which I am working. Because the thing about smoking, you know for what I do, smoking is, you know, a 5-minute break. | Gives the nurse valuable information about his life and the context in which he will be trying to make these changes. |
| Nurse | Yes. | |
| David | You need that 5-minute break throughout the day. | His resistance to changing what he eats is now showing in the form of switching the conversation to talking about smoking! |
| Nurse | Yes, so your breaks are all associated with the things that aren’t very good for your heart! | Lighthearted reflection acknowledging that a lot is being asked of him. |
| David | They seem to be don’t they. There’s no hope for me. [Laughs] | |
| Nurse | Stop for a smoke, stop for a burger or go to the pub yes. Well sandwiches are a good option because bread is quite filling. If you can think of low-fat things, if your wife can help you think of low-fat things. And stick some salady things in. Fruit is really good, I don’t know how much of a fruit eater you are. | Directs the conversation back to the agenda with a summary of options they’ve considered so far. Then moves to exchanging information about more options. |
| David | Yes, fruit is all right, yes. | |
| Nurse | You can eat tons of that. You don’t have to just have an apple. You can… | |
| David | Keep scoffing it can you? | |
| Nurse | Yes, absolutely. | |
| David | Right… get a bit of fruit inside me. | |
| Nurse | All right, so it looks as if for the moment… | Thinks, mistakenly, that he has accepted her suggestions and an agreement has been reached! |
| David | It’s a big change that, isn’t it? Going from burgers to sandwiches and that. | Back comes the resistance! |
| Nurse | Well it is, yes. Does that feel almost too much to do? | Technically a closed question but with the intention of restoring congruence. |
| David | No, I suppose it’s important isn’t it. I don’t want to end up where I ended up a few weeks ago, do I? The last thing I want. I don’t want my kids coming in, seeing me laying out in a hospital. Looking like a, I don’t know. It must have scared them. | Congruence restored, resistance settles down again and David reminds himself why they are having this conversation. |
| Nurse | Must have scared them. | Reflection. |
| David | It scared me, I am telling you. I don’t mind admitting it did. I was terrified. | This can be seen as change talk. He is giving himself good reason to make the behavior change. |
| Nurse | OK, so we’ve agreed that the food is the best place to start. Particularly lunches. Can I ask you some questions to get a feel of it? How important… if I asked you how important it was for you to start to eat differently, since you had the heart attack, on a scale of 1–10. 1 is it’s not important at all and 10 is it’s really important, where would you put it at the moment? | Faced with such mixed messages from him about his willingness to change, tries a scaling question to clarify. |
| David | Well, if it’s going to make a difference you know. Umm, about 9 or 10. It’s pretty important isn’t it? | The scaling has moved him away from resistance again. |
| Nurse | And it’s as high as that because of your fear that you talked about. | Reflection of previous change talk. |
| David | Yes. | |
| Nurse | How it’s really shaken you up. | Further reflection. |
| David | If I can change what I’m eating at lunch time and that will, you know, cut down the chances of this happening to me again…then it’s a 10. | |
| Nurse | It’s a 10. So, if you are absolutely sure it will make a difference, yes. OK, that’s something we would be able to measure, the difference, because we can measure what level of things are in your blood. | Reflection and information exchange. |
| David | Oh right. | |
| Nurse | So we can actually check your cholesterol levels, and give you some feedback as to whether… | Recognizes that he needs evidence that he is achieving his goal, i.e. reducing the risk of another heart attack. |
| David | Whether it’s actually doing anything? | |
| Nurse | If it’s working, yes. And if I was going to ask another similar question, 1–10 question but say this time how confident are you that you could do it? How do you feel? 1 is I can’t do it and 10 is yes, if I make my mind up. If you made your mind up and were determined, do you think you could do it? Where would you… | |
| David | About 5. | |
| Nurse | A 50:50 chance. | Reflection. |
| David | Yes it’s like, I know what I should be doing. It’s like smoking. I know I shouldn’t be smoking but I still do it. It’s like I know what I should be doing. I know I should be changing what I am eating. So that’s the 5 bit. It’s the actually sitting in the office, with phones going and people coming in and problems mounting up and, it’s… | Elaborates. |
| Nurse | So, it sounds like you, it might not be that much of a priority. Hard to keep it a priority when you are in work, when you are busy. | Reflection. Importance and confidence somewhat intertwined at this point. |
| David | That’s it. | |
| Nurse | It’s a priority now because you are sitting in a health setting… | |
| David | That’s it. | |
| Nurse | …talking about your heart. | Following, so as to understand his position better. |
| David | Exactly yes. And it was only a few weeks ago, wasn’t it. But in 4–5 months time. You know, a heart attack could seem a thing of the past. | |
| Nurse | Yes and that does happen for a lot of people. | |
| David | It might be that I can do it for, you know, 2 weeks, 3 weeks. Another thing you have got to bear in mind is I am going to get some right stick from the lads. You know, if I start eating fruit. That sounds funny doesn’t it, but… | Here comes more resistance. |
| Nurse | Yes, well that’s a concern, but on the other hand, when you say 50:50, that’s half of you thinks you can do it. | Moves back to ‘Why so high?’ to elicit the change talk side of the inner conflict. |
| David | Yes, that’s true. | |
| Nurse | So it’s kind of… | |
| David | Because it’s that half I need to be… | |
| Nurse | Yes, what’s that half about? What’s the bit of you, the bit that says it’s important and you want to do it? | Goes back to importance. |
| David | Yes, and the bit about being scared. You know. Like I said before I don’t, I don’t want to end up, I don’t want to be sitting here again in 2 years time having the same conversation. You know what I mean. I don’t want that. | Confirms importance. |
| Nurse | No. | |
| David | Because if I am, no offence to you, but if I am, it means I have had another heart attack. | |
| Nurse | Absolutely yes, we like it when we don’t see people again. | |
| David | Yes. | |
| Nurse | Yes. So confidence in terms of it’s important to you. What about in terms of it actually being possible to get your sandwiches together and go to work, and have a proper break. How possible does that feel? | Having confirmed importance, moves back to confidence. |
| David | Well getting the sandwiches done is no problem ‘cause you know my, my wife, we do it anyway. She has sandwiches, the kids have sandwiches for school. So it’s just like… | |
| Nurse | There’s a system there. | Reflection. |
| David | It’s all set up. You know what I mean, it’s not a problem. It’s like, you know, I just haven’t bothered before. So, actually at work I think that’s going to be the biggest issue. You know, actually going, I am having half an hour, eating my sandwiches… | |
| Nurse | Right, so it’s actually taking the time out. The sandwiches, presumably once they are there, it’s easier than sending for a burger. | |
| David | Yes if they are there… | |
| Nurse | It’s not that, kind of, not that, that’s an issue. You will eat them, it’s whether you actually take a break. | |
| David | The trouble is, what I might do is I might eat them about 11 and then still have a burger. [Laughs] | |
| Nurse | So you need to take plenty. | |
| David | Yes. | |
| Nurse | Right. And you are not overweight so we are not worried about the quantity that you are eating. | |
| David | No, I don’t think I’m overweight. | |
| Nurse | If you eat more healthy food, that’s not an issue, your weight, so that’s not something you have to worry about. | Providing information. |
| David | OK. | |
| Nurse | OK, so it’s really important for you to do it. | Begins to summarize. |
| David | Yes, definitely. | |
| Nurse | It’s just the kind of day-to-day trying it out, see how it goes. | |
| David | Yes, I guess that’s all I can do and I have got to give it a go. | |
| Nurse | Yes. | |
| David | There is no point me sitting here and saying ‘Oh yes, it’s very straightforward for me.’ There is no point in me telling you that is there, because that’s not true. I actually think it’s going to be quite hard. | |
| Nurse | Yes. | |
| David | It might sound stupid to… | |
| Nurse | Well, breaking habits is hard, it’s always hard. | Seeking to encourage without giving unrealistic assurances. |
| David | That’s what it is, isn’t it. It’s like a habit. That’s what it feels like. | |
| Nurse | Always hard. Yes, as I say, if we keep in touch we can, like when things, next time, to find out what’s difficult. You might find, some people find that some things they thought would be really difficult are quite easy and some things that they thought would be easy are quite difficult. We can kind of see how it’s going and talk it through a bit. | |
| David | OK, good. | |
| Nurse | All right. | |
| David | Thank you. |
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