AANP Member Spotlight: Creating a Culture of Health in the New Year

CDR Melissa Troncoso, MSN, NP-C, CHWC

Hear from Commander Melissa Troncoso, a PhD candidate at the Uniformed Services University of the Health Sciences and a member of the American Association of Nurse Practitioners® (AANP), on how nurse practitioners (NPs) can support their patients’ health improvement goals in the new year — and beyond.

Q: Have you always had an interest in the health and wellness field?

A: Part of my journey in health and wellness stems from my beginning in the United States Navy. I was on an NROTC scholarship while I was getting my undergraduate degree and, while I wasn’t an unhealthy person, I didn’t always maintain healthy habits. At first, my goal was to get within the required weight standards. It then evolved into improving my physical and nutritional fitness. At each duty station, I found a way to further develop my interest in this field by talking with service members and helping others improve their health. Over time, I started learning more and realized that I wanted to share my findings with more individuals because there’s just so much information available.

Most people want to be healthy and want to achieve their best lives, but there’s so much that gets in the way. What we as health care providers can do is partner with our patients and say, “Here is a simple way of thinking about your lifestyle and health. Let me share my knowledge and uncomplicate things so you can take positive steps in your daily life.”

Q: What are some of the factors that influence our health beliefs and behaviors?

A: The research in which I am involved explores factors influencing eating behaviors among junior enlisted service members (SMs). In a qualitative research study, we looked at different determinants of food choice and consumption. We were interested, from a socioecological perspective, in what was within people’s control and what was an external factor contributing to their eating behaviors. Within the military and as a society, there is a lot of responsibility placed upon the individual; wellness programs focus on helping each individual participant change their behavior. While it’s important to improve an individual’s knowledge and self-efficacy, if they are placed into an environment that doesn’t support those healthy behaviors, it can be very hard to maintain healthy habits.

Eating is very complex — it’s influenced by everything, from our relationships and physical environment to macrolevel systems like nutritional policies and social media. It’s important to recognize these factors when you are counseling people and partner with them on their eating habits. I’ve asked questions like, “In the past year, have you attempted to eat healthy?” Many people will say yes, so I ask, “How successful were you?” Many report success at the beginning, and then list the barriers that have gotten in the way of their goal. Typically, those barriers are a lack of support from family members, long work shifts, limited access to a full kitchen, disappointment with slow progress or simply the social norms of their peers.

From the clinician perspective, we have to look at how people make healthy decisions based upon the resources available to them and consider the health of the whole person. Sleep is a major determinant of health. We’re recognizing now the implications of stress on weight gain and an increased drive to eat. Our connectedness to others and our social relationships are integral to our mental well-being. All this goes hand in hand with physical activity and healthy eating.

The military has a concept called Total Force Fitness, which includes eight domains of fitness: psychological, financial, ideological and spiritual, social, physical, medical and dental preventive care, nutritional, and environmental. All these domains come together to fuel fitness and optimal human performance.

Q: What is a culture of health?

A culture of health is defined as: ‘‘a web of social influences that manifests itself in shared healthy beliefs and behaviors.” There are concepts like leadership support, cultural norms, shared values of a cultural group, climate, morale, policy and peer support that play a large role in our ability to achieve a healthy lifestyle.

A culture of health is not the same as a wellness program. While wellness programs traditionally see an organization offering a step-by-step guide or posting flyers on a health topic, such as weight loss, these programs do not address the beliefs, norms and traditions ingrained in a culture. In addition, there may be gaps between what an organization says and its actions. An organization may emphasize healthy eating, but stock 10 vending machines full of junk food. In some military cultures, high demands may mean having to complete your physical fitness training on your own time; if you have time to fit your physical fitness into your working hours, it may be perceived as you not having enough work to do.

Creating a culture of health is about changing this narrative, shaping the culture to support healthy choices and effecting positive, long-term change.

Q: How can health care providers, such as NPs, help to support a culture of health?

A: Coaching strategies can assist individuals in identifying what actions within their own personal system work to support their health goals. We can ask, “How important is it for you to change this behavior? How easy do you think it’ll be to make this change?” Using motivational interviewing strategies allows patients to connect their health behavior goals to their values, consider the reasons behavior change may work, identify what it will take to make change easier and help see what they can control within their environment.

We can also ask ourselves: “How are we connecting with community partners for our patients?” We can identify community-wide health issues, such as when there is a high number of patients with diabetes within a population. However, when we go to tackle the problem, the community may have other, more pressing needs. If we partner with leaders within the community to incorporate and address those additional needs, we can then address the disease of diabetes together.

We can advocate at the senior level of our organizations for change and challenge leadership and staff to consider what it would look like if they were to support and reward healthy behaviors and push back on behaviors and practices that undermine health and wellness. We can also be role models of healthy behaviors for our patients, families and communities.

Q: Since January is a time when many individuals are setting resolutions for the new year, how can NPs best support their patients’ new health habits, keeping in mind the need to create a culture of health?

A: Rather than resolution — which typically is an all-or-nothing proposition — I encourage people to set goals, specifically concerning behavior rather than outcome. Behavior is some action you can take, such as eating one vegetable at every meal, versus an outcome, such as losing 30 pounds. This allows the individual to have more control and be intentional about the steps they need to take to meet their goal.

I always like to tell people to start with “why.” Why do you want to make this behavior change, and how can we add clarity around your motivations for this change? It’s connecting your goals to your values. It’s not, “I want to lose weight,” but, “I want to be able to play with my kids.” If we look at the transtheoretical model of change, sometimes people need more time to mentally work through the pros and cons or possibilities and alternatives before jumping into action.

We can start with identifying what the individual is already doing and evaluate whether those actions are working — or aren’t working. We can take that big goal and break it down into quarterly or smaller goals. For someone with a goal of eating healthier, the first quarter may be keeping track of what they’re eating, the second may be speaking with a dietician about making changes and the third may be easing into those changes. When we focus on helping people change their behavior, a long-term approach requires consistently building on small victories.

I recently read about the concept of planning backwards: Imagine you’re at the end of your day and list everything that made your day great. Then, mentally prepare to do those things. That might look like ridding yourself of things that aren’t serving you, such as scrolling social media. It might be “eating your frogs first,” or completing the most difficult tasks first. It might be eating more of a certain fruit or vegetable when you notice that it energizes you and makes you feel good.

When we consider COVID-19 and influenza season, if people are engaging in these healthy behaviors, they’re building a stronger immune system. We may have to take certain measures that aren’t so fun, but we can manage the things we can control. I can drink more water today. I can think about my diet in terms of vitamins on a plate. I can do what will help me build my immune system so that I can be stronger.

Q: Why is it important for health care providers to set their own wellness goals?

A: As NPs, we often have a sacrificial servant mentality. It’s important to remind ourselves to do what we can to improve our health. If you know you aren’t going to prioritize self-care, have an accountability buddy. My colleague, who knows me well, and I look out for each other. We’ll ask, “Have you moved out of your chair today? Have you taken a lunch break?”

The terminology “self-care” may conjure up the idea of selfishness, but it’s not selfish! When we are at our best, that’s when we can best take care of others.

AANP Resources Address NP Wellness and Clinician Burnout

Check out the latest information on guarding against clinician burnout, with resources from AANP and other notable health care sources. This new NP Wellness resource page will provide current information on how to protect your well-being in the very chaotic world we inhabit.

Visit this new webpage for resources that will help you — and your patients — enjoy a less stressful, more productive life. New information and tools will be added to this section regularly, so check back and see what you can do to take action against clinician burnout.

Review NP Wellness Resources