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Can we do more to shift fixed beliefs and behaviours like smoking?


The recent decision to stop young people being able to buy cigarettes is radical and potentially divisive, but ethical dilemmas aside, is it the right thing for health, and what is the nurse role in this, asks George Coxon

Many of us listened with interest to the debate that led to MPs embarking upon a process to ban smoking preventing anyone born after 1 January 2009 being able to legally buy tobacco in the UK in the future.

This is an issue that may divide the nation, and I’m sure that the subject of how we change behaviour that we know causes harm will see much media and general public interest, even for those who have never smoked like myself. One dilemma perhaps is about legislating about liberties and choices: for example the Mental Capacity Act 2005 includes a principle about having the right to make unwise decisions; we might all perhaps have something of a moral dilemma in how we feel about the ban. Behaviour change, of course, is a topic always close to the hearts of nurses.

Our everyday life and work have many moments and opportunities to alter behaviour for ourselves and those we aim to help. Shifting fixed beliefs, lifestyle habits and patterns that can and do cause damage is core to what we are trying to do as nurses – but can we do better? How many of us sometimes struggle to understand, and then positively intervene, to change what we consider to be people’s damaging beliefs and behaviours? This can be a challenging part of our roles.

We all know well that lifestyle choices and well-established habits can have serious negative health and happiness consequences. Take some of the more obvious examples, such as smoking, excessive alcohol consumption, poor diets and lack of activity and exercise.

All of these behaviours can be hard to change, and we know that simply giving advice can often have limited impact and may produce defensiveness and denial. Even with a good evidence base, well-intentioned advice can produce resistance. Our suggestions to patients can even damage the nurse-patient relationship, if our attempts to help are seen by someone as judgemental or as personal criticism.

Attitudes and beliefs are core to who we are, and the negative ones can become unshakably entrenched. Influences include early life experiences and learning, family views and values shaping what we think and do, as well as the nature/nurture part of how we learn and develop our opinions.

The things that reinforce our sense of right and wrong and how we live can lead to rewarding ourselves in what psychologists call ‘maladaptive behaviours’, together with ‘cognitive dissonance’, when we know that something is bad for us, but we just keep doing it.

At the same time, the power of mainstream media and social media to influence our views, opinions, ideas, choices, beliefs and behaviours and has never been more prominent. Close relationships with others are also a powerful shaping factor to what we think and do with the views and ideas of people we admire trust, respect and wish to emulate. 

Wouldn’t it be transformative if there were simple answers to the following questions:

  • Who or what causes us to hold the beliefs we do and how able are we to alter what we do?
  • When are we at our most receptive to change?
  • Are we more open to change as we mature – increasingly questioning and reflective about the world we live in – or is it the opposite more likely?

Shifting damaging habits and perceptions and promoting positive behaviours, are an essential part of the nursing role.

There are definitely no simple answers, but approaches are perhaps for us to be flexible in establishing trusting trusted relationships in our work so we can have better impact on outcomes for long term benefit.

Can we do more? My advice is to reflect and share approaches with colleagues – to use supervision and case reviews as well as be receptive to learning and read on approaches and seek out examples of things that work to adapt and apply to our practice too. In particular, what more can we do to reach the hard to reach, and to influence entrenched habits and behaviours?

Most people have ambitions to change something. It’s rare to find anyone not seeking to add or remove something in their life. That might be to lose weight, eat more healthily, exercise more, read more, sleep more, spend more time with loved ones, keep in touch with friends more, declutter our lives, or to set a target or two.

While our motivation to do this might be a fluid thing, but I’m a strong believer in some core ideas on how we enable people make better choices.

A lot of work has been done using tools and techniques in mental health, such as motivational interventions, that aim to enable insights and empowering a person to develop new coping strategies. I’ve spoken before, too, about ‘planting seeds’ and building and making connections to facilitate change with those we care for.

One of the challenges of the work we all do in person centred care is that no two people are the same, and so changing beliefs and behaviours must have a totally individualised approach.

This is perhaps something to ponder on when we approach our next clinical contacts. We all have the potential to influence and change behaviours of those we support – it’s a question of how, and if we are agile enough in our person-centred approach to adjust to an individualised way to do this.