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9. Implement Better Interventions 

Clearly identify the problem

Focus the intervention of the most likely problem identified with the “Road

Map”. By using the “Road Map” described above, you will have identified

the most likely problem, the first diagnostic tests that need to be performed,

and the most beneficial interventions. By clearly identifying the problem,

you won’t be wasting time on interventions that aren’t helpful.

Look for research to validate our practice

We call this “Evidence-based Practice” (EBP). When you read journal

articles, look for the research that supports proposed interventions. There

are a lot of good resources on the internet for EBP. Start with the Agency

for Healthcare Research and Quality (formerly the Agency for Health Care

Policy and Research—AHCPR

http://www.ahcpr.gov/clinic/epc/

, next try

the Therapeutics Initiative: Evidence-Based Drug Therapy:

http://www.ti.ubc.ca/

or The Joanna Briggs Institute for Evidence-Based

Practice:

http://www.joannabriggs.edu.au/

Get “buy-in” from the patient and family

Try to achieve cooperation from the patient and his family by using the “6

A’s to Health Promotion”

1.

Assess: Use a short, well-directed interview. Remember that self-

reported behaviors are usually underestimated.

2.

Approach: A warm, empathetic, and non-judgmental approach is

better received by the patient.

3.

Advise: Personalize the risks and benefits to the patient, while

emphasizing “quality of life”.

4.

Agree: The patient will be much more willing to implement change if

there is a mutual agreement based on compromise. Ask “How

important is this change to you? and how confident are you that you

can make the change?”.

5.

Assist: Self-management skills and resources are important. What

are her sources of additional assistance?

6.

Arrange: Follow-up and resources. Patients are 30% more likely to

comply with treatment if they know there will be follow-up. 

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