Live What You Say with The Patient Promise


By Megan M. Krischke, contributor

Nurses may not have all the answers for their patients, at least when it comes to conquering personal challenges related to nutrition, fitness and weight. At the ANA Healthy Nurse conference in June, 380 nurses took a short health risk assessment that showed how the nursing population struggles with these issues, too. Seventy percent of those surveyed were in the overweight or obese category; only 35 percent exercise 4-5 times per week, as recommended; and only 40 percent eat the suggested four or more servings of fruits and vegetables a day.

How can nurses make the changes that will improve their health and help their patients do the same? One way, according to the American Nurses Association (ANA) and other clinician advocacy groups, is to become personally accountable and sign The Patient Promise, a commitment made by healthcare providers to pursue the same healthy lifestyle they promote among their patients.

The Patient Promise made its debut in June 2012, and now has close to 600 signers representing 40 institutions.

“These are exciting times for The Patient Promise and what it stands for: namely, improving the health of patients by improving the health of clinicians,” began Shiv Gaglani, MD candidate at Johns Hopkins School of Medicine and co-founder of The Patient Promise. 

“Within the first year of medical school it became apparent that the new lifestyle we were entering into was not exactly conducive to living healthily. It was all-too-easy to succumb to stress, junk food and sedentary behaviors. The epiphany behind The Promise came when we [Gagliani and his classmate and co-founder, David Gatz] were taking a class on preventive medicine that highlighted the immense problem of lifestyle-associated chronic diseases, both in terms of disease burden and rising costs.”

“We realized that we were heading down the same path as our patients,” he continued. “It became a priority for us to maintain our personal health so that we not only felt and performed better, but also so we could lead by example and partner with our patients on the shared journey to better health. We were enthused by the fact that there was actual research showing that clinicians who practiced what they preached were more likely to engage patients in conversations about adopting healthier lifestyle behaviors. Many of the authors of these studies are now advisors to The Promise.”

The Promise’s co-founders hope that it will raise awareness of important issues such as weight discrimination and the importance of regular physical activity. Signers are already providing feedback about their commitments to quit smoking and shed weight.

“We are a grassroots initiative started by students, and thus hope to change the culture of health care so, once we are practicing, it becomes more common for us as clinicians to speak with each of our patients about incorporating healthy lifestyle behaviors,” stated Gaglani. “Leading by example is an evidence-based and common-sense concept and we hope The Patient Promise encourages individuals and even entire groups or institutions to aim to do so.”

“Even before signing The Promise, I valued the concept of living well and maintaining a lifestyle consistent with what I would promote to my patients and students,” said Tam H. Nguyen, RN MSN/MPH PhD, faculty research associate, Center of Excellence for Cardiovascular Health of Vulnerable Populations, Johns Hopkins University School of Nursing. “But I wasn’t doing all that the American Heart Association recommends--eating five fruits and vegetables each day and getting 30 minutes of exercise five times a week. Signing The Promise was good because it put in precise and eloquent words a professional statement that adds accountability and clarity.”

The American Nurses Association (ANA) has thrown its support behind The Patient Promise. Suzy Harrington, DNP, RN, MCHES, director of ANA's Center for Health, Safety, and Wellness says The Promise aligns well with the Center’s dedication to empowering nurses to be stronger role models, advocates, and educators—individually, within their families, their communities, their work environment and for their patients.

Harrington encourages nurses to sign The Promise because it demonstrates a more formal commitment, and such commitments have been shown to support behavior change.
“Because nurses typically spend more time with patients than other clinicians, they have more opportunity to speak to and influence patients about wellness and chronic disease issues,” Nguyen pointed out.

“Nurses are the most trusted profession and, thus, have an opportunity to really make a difference,” added Harrington. “In addition to being better role models, being healthy actually allows us to be better nurses--we are less fatigued, have more energy, are more ‘present’ and have fewer sick days, and fewer risks of errors.”

“As we struggle with our own unhealthy behaviors, we build the strength and resilience skills we can share with our patients when they say, ‘I don’t know how to do it,’” she continued. “We can then add personal experience to our evidence-based education. We are not asking patients to do anything we won’t or can’t do ourselves.”

“The Promise recognizes that these changes require time and continued reinforcement and it speaks to the fact that these choices, as simple as they are, are hard to do even for people who know better. It is a commitment on the part of providers and patients to be on a journey together,” explained Nguyen.

Additional resources for nurses:

Read and sign The Patient Promise.

Visit The Wellness Council of America for free resources and information on organizing a wellness program at your facility.

Visit ANA’s Healthy Nurse page for access to current health, safety and wellness resources.

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