The Nurse Practitioner Is In

I don’t believe in new year’s resolutions.

I think the concept is good – the new year is a convenient mile marker, of sorts, for making a personal change – but I think the timing is bad. When it becomes expected that we will make some major change in our lives (which will also, magically, make our lives better), and that it will happen on a schedule and that there will be obvious results – to me, that’s a recipe for failure. When you set it up that way, it’s too much pressure for the majority of people to be successful.

Another risk with new year’s resolutions is the pressure to pick something, anything, and call it a resolution. Based on personal experience (and the experience of almost everyone I know), a lot of new year’s resolutions are arbitrary and poorly defined. They are also very often abandoned before you can say “Valentine’s Day.”

This year, instead of making some random resolution, why not commit to learning more about yourself and how you can prepare for a personal change you’d like to make (at some point in the new year)?

There is an approach to understanding and (ideally) maintaining behavior changes called the stages of change. This model was developed approximately 40 years ago by researchers* studying people working to quit smoking. I think of this framework like a route with a bunch of stops between where a person is currently and where they will be after fully making a change.

For some changes, a person may be at the first “stop” and for others, they may be further along at the fourth or fifth “stop.” Let’s look at these stops in some more detail; to illustrate, let’s use the example of someone who doesn’t drink enough water each day.

The first is called Precontemplation. At this point, a change is generally not on a person’s radar; I think of this sometimes as people who don’t think the risks associated with a behavior will apply to them, that they will somehow dodge the bullet. EXAMPLE: “They say you are supposed to drink at least two liters of water each day, but I’ve never had any trouble because I don’t get enough water.”

The next stop is called Contemplation. A person at this point has not made the commitment to change, but it is on their radar. Someone here might be considering the pros and cons of the change. EXAMPLE: “I read something about how much water you are supposed to drink each day, and I am not even close to that; I drink maybe a glass or two each day. The article also said that having enough water would improve my sleep and help my body absorb nutrients from food. But if I drink two liters of water a day, I’ll be in the bathroom all the time!”

Moving on, we come to Preparation. At this point, folks are making concrete steps toward changing a behavior. When at the preparation stage, people are indicating (to themselves and others) with their behaviors and choices that they realize a change is needed. EXAMPLE: “Well, you have to drink something each day – it might as well be water. I might not make it to two liters every day, but anything would be an improvement compared to how much water I drink now.”

Next up is Action. I think of this as the “heavy lifting” portion of the process of change. When people have progressed to this stage, they are doing the work of the change in question and finding ways to sustainably incorporate this behavior change into their daily lives. EXAMPLE: “I thought that it might be hard to drink this much water every day, but once I got in the swing of it, it’s not hard. Playing around with different flavor combinations has also helped to keep it interesting; I like crushed blueberries and lime – who knew?”

The final stop is Maintenance. When people have made it this far in the change process, they have successfully incorporated the change into their daily lives and are experiencing the associated benefits. Ideally, they will keep going with this new behavior; depending on specifics, this may require more or less intentional effort. EXAMPLE: “I don’t know whether I’m absorbing nutrients better, but the quality of my sleep has improved and I haven’t had a headache since I started getting enough water regularly.”

If you decide to make a change at some point in the new year (no pressure!), give some thought to where you are in the stages of change. Think about what it would take to progress from your current stage to the next stage, and why that would be important to you. It could be very beneficial to write your thoughts down so that you can refer to them as you continue to make progress.

And if you start making a change and find yourself going in the opposite direction, give some thought to that, too. It doesn’t mean you are a failure; maybe it means that you tried to go too quickly, or that your change was too big and should be two or three smaller changes that will add up to a big change.

Perhaps the best advice is to give yourself a break. I have not seen lasting benefit come to anyone who was hard on themselves. Having a goal and a plan to get there – that’s where I have seen real, lasting change. Happy New Year.

Take care, Jessica

Jessica Reeves, MSN, MPH, APRN is a Nurse Practitioner based in Keene. Learn more at*Reference: Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.