This article is part two of a series exploring the role of the nurse, midwife and other health professionals within public health and the Making Every Contact Count (MECC) approach (Craig and Senior, 2018). This article will explore the use of brief interventions.
MECC (Public Health England et al, 2016) is an approach to behaviour change that uses the day-to-day interactions that nurses have with patients in order to support them in making positive changes to their physical and mental health and wellbeing. Brief interventions are linked with MECC through conversations where the health professional engages with individuals about their health and lifestyle choices.
Every day, nurses care for patients whose health-related behaviour and lifestyle choices have made a significant contribution to their illness, comorbidities or the likelihood of a premature death. Nurses have a duty to promote health (Nursing and Midwifery Council (NMC), 2018). Addressing smoking, alcohol misuse, lack of physical activity and a poor diet contributing to obesity could make substantial improvements to health, wellbeing, life expectancy and, in turn, would help reduce health inequalities (Fuller, 2015; World Health Organization, 2017).
The NHS Five Year Forward View (NHS England, 2014) highlights the necessity for health professionals to focus on preventing illness, with NHS staff using every patient contact as an opportunity to help them stay in good health and reduce the risks of poor behaviour choices. NHS England (2014) promoted various National Institute for Health and Care Excellence (NICE) guidance on individual behaviour change, smoking, drinking, alcohol, obesity and physical activity as integral to clinical pathways, care plans and treatment (Fuller, 2015).
Lamming et al (2017) suggested that brief interventions have the potential to reduce the public health burden of poor behaviour choices at a relatively low cost (NICE, 2014a). NICE defines brief advice as:
‘Verbal advice, discussion, negotiation or encouragement, with or without written or other support or follow-up. It can vary from basic advice to a more extended, individually focused discussion.’
However, establishing a consensus definition of a ‘brief’ intervention is a challenge, and different definitions are used for ‘brief interventions’ and ‘brief advice’ (NICE, 2007; 2010; 2013; Lamming et al, 2017; NICE, 2018). Nevertheless, brief interventions can be described as short, time-limited interactions and conversations aimed at guiding the discussion in a way that provides information alongside encouraging motivational change.
The potential to deliver brief interventions presents itself to nurses during consultations or during routine nursing interventions.
Examples of these opportunities include:
The efficacy of brief interventions and whether they help change behaviours predominately relies on the nurse listening to and being empathetic to the patient's point of view. These interventions may be:
Very brief interventions
These are defined as very short interventions, taking anywhere from 30 seconds to two minutes, which can follow the approaches set out in a couple of tools that help frame the discussion. These will be explored in Part 4 of this series.
Brief interventions
NICE (2014b) recommends that any staff who have contact with patients whose ethnicity, family history, lifestyle choices or behaviours could put their health at risk should be trained to deliver brief interventions.
A brief intervention can last anywhere from two minutes up to half an hour and will involve discussion, negotiation or encouragement. Brief interventions involve deeper conversations with the patient than those in very brief interventions, in order to offer insight into health-related behaviours and lifestyle choices. The discussion is aimed at harm reduction, raising awareness and the sharing of knowledge, and takes a further step to help initiate change. The discussion may include identifying the patient's level of motivation to change behaviour and/or if a referral for further support or interventions is required.
Extended brief interventions
An extended brief intervention is a lengthier version of a brief intervention, usually lasting more than 30 minutes. This time is spent on a more individually focused discussion, exploring motivations, barriers and the likelihood of changing behaviour. Extended brief interventions can be single or multiple interventions. Predominately, these are services commissioned and provided through primary care local enhanced services such as smoking cessation or weight-loss services, or those to support a reduction in drug and alcohol consumption.
Making the most of patient contacts
Delivery of very brief and brief interventions should be part of the routine work of almost every nurse, but many opportunities to give relevant and appropriate advice are allowed to pass (Jacobsen et al, 2005; Prime Minister's Commission on the Future of Nursing and Midwifery, 2010). Reasons for this may include the practitioner feeling they do not have enough time, have too many patients to deal with, do not feel responsible for the task, or feel they do not have the appropriate knowledge.
Given the current drivers for MECC and the introduction of very brief interventions, it is reassuring to note that the time required to deliver a very brief intervention is minimal. Not every patient will require further interventions, therefore promoting health and wellbeing along with preventing ill health should become routine practice.
In order for a nurse, midwife or other health professional to deliver brief interventions, however, they need to be competent in delivering them. The nurse, midwife or health professional must be competent to:
Acquiring competence requires development from initial awareness of the public health drivers that steer all nurses, midwives and other health professionals' practice to gaining new knowledge and skills to consciously carry out very brief, brief and extended brief interventions. Making such interventions will soon become second nature and part of routine practice.
Conclusion
It has been acknowledged that nurses, midwives and other health professionals are the most suitably placed to offer interventions that may improve the health and wellbeing of patients and their families.
This article has discussed the different types of brief intervention, with very brief and brief interventions identified as the desired intervention for all nurses, midwives and health professionals to perform as routine practice. The next article in this series will discuss the behaviour change models that nurses can use when engaging their patients and the general public in changing their behaviour.