Saturday, September 17, 2016

Anticipatory Grieving - 4 Ways to Prepare for the Impact of Alzheimer's

“People think it's just forgetting your keys, she says. Or the words for things. But there are the personality changes. The mood swings. The hostility and even violence. Even from the gentlest person in the world. You lose the person you love. And you are left with the shell... And you are expected to go on loving them even when they are no longer there. You are supposed to be loyal. It’s not that other people expect it. It’s that you expect it of yourself. And you long for it to be over soon.”  

It was 1987, and I was just beginning to learn about the impact that Alzheimer's has on people and those they love.  In the auditorium that day there was a sense of excitement of dreams and hopes to soon be realized.  I was a joyful teenager, and it was the day I was finally going to graduate from high school.  In the audience I was supported by a hoard of family members, who would have to endure the typical never-ending roll call that occurs with each commencement ceremony.  On that day my parents were particularly nervous about the ability for my Grandma to endure this marathon of names.  Over the past year we had all noticed that she was slipping in remembering known details, and couldn't do the things she once had with the same ease.  We all just chalked it up to old age because what was Alzheimer's?  At that time it seemed like just a strange word that wouldn't impact our world.

Soon enough it all began to change as my Grandma looked at my cousin sitting next to my Mom, and proceeded to ask her who it was every two minutes for the duration of the event.  Then it was the trip to McDonald's when my Grandpa thought he could leave her unattended, but quickly realized it was a mistake when he found her eating left over food at another table.  The next months and years would play out much like many others have experienced.  The childish tantrums, the lost jewelry, and the undergarments worn outside her clothes.  It took it's toll on our family, specifically on my Grandpa who was never able to grasp that it was a disease and not a choice that was taking a wife, a mother, and a grandmother.  Then in the early 1990's she went to the hospital following a heart attack, and was released of her suffering into glory with her Savior in a moment of clarity as she sang "How Great Thou Art".  As I'm writing this excerpt the tears are again welling up in my eyes after all the years, but the pain is beginning again. 

Over the years I've cared for patients who've had end stage diseases that have robbed their families of that person.  Along with those other tragic terminal illnesses Alzheimer's also has the ability to be particularly cruel because it robs us of the person long before they leave this world. When your loved one has Alzheimer's or a significant memory loss, how do you deal with the anticipatory grief of losing that person?  Through my personal experience as a family member and a health care advocate, I hope to share some insights that will be useful to those facing this agonizing journey.

Anticipatory Grieving - 4 Ways to Prepare for the Impact of Alzheimer's

Feel the Loss - As a hospice nurse I've seen many people grieve over the years in various ways, and those who've accepted their pain have seemed to survive the storm.  The same should be true of those facing the challenge of losing their loved one to Alzheimer's because it is like the thief that comes in the night, and you wake up with nothing.  In order to get through this tragedy we must feel the loss, so we can focus on enjoying whatever time and quality of interaction we may have left.  This disease primarily has a specific course that it runs, but there may be variations of the disease that progress quicker than others.  Being aware is the first step in dealing with this challenge.

Understanding the Journey - Knowledge is power, and I believe that people do better when they understand the challenge they're facing.  When you're informed you can develop strategies on how to overcome this horrible situation, have the ability to choose how you'll react, and reduce your stress by knowing about the changes you'll soon see in your loved one as the disease progresses.  Part of preparing for this journey is to gain knowledge because it will give you power, and help you focus your perspective.  You can tap into agencies like the Alzheimer's Association or the Area Agency on Aging to find resources to support your understanding and needs.

Fight with all Your Might - In our lives we all have challenges that occur that require us to persevere and fight to prevent becoming overwhelmed.  Alzheimer's is another challenge that deserves a fight with all your might.  There is a lot of research being done to end this disease, but until it's cured we need to be proactive by advocating for our loved one's needs.  It may be getting to a provider involved in research studies, having your loved one started on medications believed to slow the progression, or by tapping into a resource that can provide practical steps to support you in this journey.  The first step in this fight for everyone is to get your loved one to a geriatric specialist or neurologist, so the diagnosis is defined that will generate the treatment options available for fighting for your loved one with all your might.

Take the Time - Life is so busy, and we all have demanding jobs, family demands, and other responsibilities that absorb what little time we have available for ourselves.  It is that time that I believe we need to spend with our loved one to maximize our interactions.  When we take the time, we can create a mental journal that will support us during the journey with images of special visits, phone conversations, and moments in time where we were able to soak up their essence.  Don't let the little time that is available slip away, but rather cherish each moment.

"As he walked into the kitchen he didn't know where to put his dirty glass in the dishwasher, he also tried to put together a child's dresser and was unable, and finally he got lost going to the store.  All I could think was it was happening again, but now it's my turn.  It was in that moment that I knew I was losing my Dad, as my Mom and I cried about the anticipated loss." 

Alzheimer's is a devastating disease, but if we attack it proactively, love those with it deeply, and cherish each moment provided then we may just make it through the loss this disease causes.  At least that's what I'm going to believe, and make my prayer for those of us facing the anticipatory grief of losing the one we love.

"We were promised sufferings.  They were part of the program.  We were even told, 'Blessed are they that mourn', and I accept it.  I've got nothing that I hadn't bargained for.  Of course it is different when the thing happens to oneself, not to others, and in reality, not imagination."
C.S. Lewis

Take care,

Thursday, July 28, 2016

A Roadmap to reaching your potential...

Good Morning,

I have a few questions for you this morning:

  • What do you want to achieve in life?  big question I know
  • How do you plan to achieve your goals or get to that desired destination?

The reason I ask is because I want to review Maslow's Hierarchy of needs, and how using some personal motivation that resides in each of us can help us achieve our goals and destiny.

The Pyramid of Needs
  1. Physiological Needs - air, food, drink, shelter, warmth, sleep, and intimacy
  2. Safety Needs - protection from the elements, security, order, law, limits, stability, freedom from fear
  3. Social Needs - belonging, affection and love - from co-workers, family, friends, and lovers
  4. Self Esteem Needs - achievement, mastery, independence, status, dominance, prestige, self-respect, respect
  5. Self-Actualization - realizing personal potential, self-fulfillment, seeking personal growth and peak experience.

What is the importance of the Pyramid in understanding how to reach our potential? 

Maslow believed that when needs are unmet people are motivated to achieve those needs first, and then seek to fulfill the higher needs - (ex. - starving people will do anything to satisfy that basic need because if they don't they won't survive)  I would hope that each of you reading this are meeting your basic needs, but this example creates a good focus for us and further justifies the thinking of Maslow.  The pyramid is just that -  A pathway of moving to a higher level of personal growth where we meet needs that either are central to our survival or will greatly enhance our human experience.

So where are you currently on this pyramid?  Do you want to find out?  Here's a quick quiz that will help:

Did you complete the quiz? 
Does it seem like an accurate assessment of where you're currently in your life?  If it is, but it's not where you want to be how are you going to change that starting today?  I want to provide some help in the form of an article you can read that outlines a process for you to start moving up that pyramid toward the goal of self-actualization.  Below is the link to the article.  I will discuss the article and provide some practical strategies related to the article in my next blog post.

I hope this has been beneficial.  Please let me know because my goal is to provide help to people in achieving their goals for personal development and health.  Thank you for visiting, and have a wonderful day.

Take care,


Tuesday, July 26, 2016

Going Against the Grain - 5 steps to achieving your dreams...

Have you ever had a dream, a desire, or a destiny you felt pulled to chase in your life?  Most people will answer that question with an emphatic yes.  Have you ever had a dream, a desire, or destiny in life that you pursued even when it meant encountering problems and going against the grain?  The emphatic yes answers to this question often decrease dramatically because people lose sight of their dream for one reason or another.  It can be a challenge to accomplish your dreams in life when you're faced with difficulties along the way, but learning how to press forward past the obstacles in your path allows you to make the dream a reality.

Here are 5 steps to achieving your dreams:

1.  Clarify - The first step to achieving your dream is to understand it, have a plan to achieve it, and be able to clearly communicate it to others.  If you aren't clear on where you're going or what you're doing then it will be impossible to have other people see your vision.  Next you've got to be able to share it with people in a way that they can see and understand the vision.  You can't expect people to get onboard with something when they're confused by the message.

In my own life I've struggled with this because my mind functions in a weird way at times.  I generally have numerous thoughts or ideas running through my head, and when I'm in a conversation I'm often processing my next response before I've even completed what I'm saying.  My wife has been my help throughout the years because she has alerted me in the moment, so I can focus and complete my sentence or train of thought.  Therefore, you've got to be able to explain your dream, hope, or vision in a way that others can see and support.  Taking this first step will get you moving toward achieving your dream.

2.  Identify - Once you are able to state clearly to others your intentions for changing the world you'll have to be ready for their opposition.  What you do next is crucial to failure or success.  In those moments it's easy to lose heart when the people you love and respect in your life don't seem to support your dream, but before you become disheartened you have to be willing to identify the cause for their reaction.

Is this someone who may have a legitimate argument or a rational reason they're questioning your hopes and dreams?  There's two sides to every coin, and in life there are many ways to look at a situation.  Therefore, you need to consider what they're saying, and does it have any validity.  If so, does that mean you need to alter your dream or just decide to agree to disagree?  That is a question you'll have to answer for yourself.  Chasing your dream will be difficult, but when you can prepare for problems and be proactive, it's much easier to quickly avert disaster along the way.  Therefore, take the time when you encounter negativity on your path to vet it for validity, so you can continue moving forward on the path to achieving your dream.

3.  Isolate - Have you ever done Spring cleaning or just went through your closet to make a Goodwill trip?  Sadly, this also can apply to relationships in our lives.  When we chase our dreams in life there may be those who don't want us to succeed by either withholding their support or verbalizing their disagreement.  Even though we may have tried to understand and respect the other viewpoint, there are times when we have to stand up for ourselves by not being anyone's doormat.  At these times you may have to isolate the negativity in your life by cutting off communication, minimizing visits, or ending a bad relationship.  The negativity can kill your dream, and can be like sitting in a dark room that becomes lighter as your eyes adjust.  If you don't isolate the opposition to your dream, you may become convinced they're right and your dream will die.  Theodore Roosevelt put it nicely, "I care not what others think of what I do, but I care very much about what I think of what I do!  That is character!" 

4.  Surround In order to stay on track in achieving your dream you have to avoid the negativity, but you also have to surround yourself with like-minded people who can understand your need to pursue your passion.  You have to find others who look at the world and it's problems as opportunities to make it a better place.  That requires finding avenues to fuel that smoldering ember within you, so that it can ignite into a raging fire that has the ability to burn fiercely in your soul until you achieve your dream.  Some of the ways that I find to stoke the fire are to join networking groups, to write a blog with the hope of inspiring others, to listen or read books that speak to my personal growth, and to seek out the chance to encourage others in chasing their dreams. 

5.  Push Forward - A dream will remain just that unless we take action to make it come true.  How will you do that today?  I just about let a dream die myself today because I wasn't going to take the action necessary to make it a reality, but then I decided to push through.  I know you have the same challenges.  Maybe it's trying to balancing your family life, responsibilities at work, and remaining healthy all while trying to find the time and the energy to pursue your dream.  To make our dreams a reality we have to dig down and push forward. 

In the Marine Corps we often called this intestinal fortitude.  Sounds insane, but I saw it first-hand as an infantry medic (Navy Corpsman) on a number of occasions.  Guys would be writhing in pain from the challenge they were facing, but looked deep inside to find the will to push forward.  All of us have that ability, but it's just finding how to dig down and release that energy.

One way to find that hidden reserve is to remember why the dream is important.  Why is the dream important to you?  Whose life is it going to impact in a powerful way?  If the dream dies who will miss the benefit of your vision?  Maybe it takes putting a picture on your mirror in the morning, or choosing a quote to put on your phone wallpaper, or choosing a phrase you can say during the day to keep you moving forward.  Somehow you have to use that special something that makes you see your dream everyday, and imagine how life will be for you and others when you finally PUSH Forward to make it a reality.

I hope and know we both have the ability to not only chase our dreams, but make them a reality that will change lives for the better.  Choose to go against the grain today, and achieve your dreams!


Here are some quotes from some other's that followed their dreams:

Go confidently in the direction of your dreams. Live the life you have imagined.Henry David Thoreau

Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience, and the passion to reach for the stars
to change the world.Harriet Tubman

No one has ever achieved anything from the smallest to the greatest unless the dream was dreamed first.
Laura Ingalls Wilder

The future belongs to those who believe in the beauty of their dreams.
Eleanor Roosevelt

So often times it happens that we live our lives in chains
And we never even know we have the key.
Lyrics from Already Gone,
performed by the Eagles
for their 1974 On the Border album

Best Wishes,


Monday, July 25, 2016

Thoughts for the Day - Randon Acts of Kindness...

It seems sad these days that there is such a lack of courtesy and kindness for one another.  I'm still holding out hope that things can change, but it requires the effort of each of us.  It takes looking for opportunities carry out random acts of kindness when we see the opportunity.  Will today be the day you act in kindness toward someone else jus because.  Here's a couple thoughts to support your actions.  Take care.


“Don't wish...DO! Don't try...BE! Don't think...KNOW! And above all: Bless a stranger with a small, yet powerful, random act of kindness. You feel me?”
T.F. Hodge, From Within I Rise: Spiritual Triumph Over Death and Conscious Encounters with "The Divine Presence"   

“Kindness carries no price tag neither does it require making a purchase. A random act of kindness can change someone's life...choose to be kind always.”
Kemi Sogunle

“Do your little bit of good where you are;
it's those little bits of good put together that overwhelm the world.”
Desmond Tutu

“Let us make one point, that we meet each other with a smile, when it is difficult to smile. Smile at each other, make time for each other in your family.”
Mother Teresa

“Be kind, for everyone you meet is fighting a battle you know nothing about.”
Wendy Mass, The Candymakers

Sunday, July 24, 2016

Thoughts for the day - Making it is all about hanging on...

Life can seem hectic at times, and feel like we're just trying to hang on.  In those moments we have to press on and move ahead with confidence and purpose.  If you've hit a bump in the road or feel like your just hanging on, here's some thoughts to help you on your journey today.

Take care,


You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, how you can still come out of it.

Maya Angelou

Many of life's failures are people who did not realize how close they were to success when they gave up.

Thomas A. Edison

Courage doesn't always roar. Sometimes courage is the little voice at the end of the day that says I'll try again tomorrow.

If you fell down yesterday, stand up today.

H.G. Wells

When you come to the end of your rope, tie a knot and hang on.

Saturday, July 23, 2016

Thoughts for the Day - Giving Makes All the Difference...

Greed, it seems like the driving force for so many individuals these days.  Today I read an article about Medicare Fraud perpetrated by three health care professionals that actually not only stole almost a billion dollars, but also hurt actual patients in the process.  It's sad that this was the motivating factor for these individuals to make money.  Making money isn't a bad thing at all, and can benefit the individual and their community if they choose to give back.  If our motivation is about giving to others, the world will benefit from our actions whether money is involved or not.  I hope today can be a day we GIVE of our hearts, minds, and wallets if you feel compelled to change your neighborhood, community, and world for the better.  Take care, and here are some thoughts on giving.


“It's not how much we give but how much love we put into giving.”
Mother Teresa

“We make a living by what we get. We make a life by what we give.”
Winston S. Churchill 

“You give but little when you give of your possessions.
It is when you give of yourself that you truly give.”
Kahlil Gibran, The Prophet  

“For it is in giving that we receive.”
Francis of Assisi 

“There is no better exercise for your heart than reaching down and helping to lift someone up”
Bernard Meltzer 

Thursday, July 21, 2016

Thoughts for the Day - The heart of a child... Lessons in caring for others

Today I went into the city with my family, and before going home we stopped by a little burger joint to avoid rush hour traffic.  It's a bit of a eclectic part of town to say the least, and has a lot for the eyes to absorb.  In keeping with the surrounding the place we stopped at only has a walk up counter with all windows.  Like usual my daughter wanted to go up and order for herself, but this time she was more enthralled with all the pigeons and then starting noticing all the people around that weren't in line.  She started to tell me how many of them had signs, and that this one boy looked very sad. 

As I was trying to remember the order I was also trying to remain keenly aware of my surroundings, and had a hand on my little girl at all times.  She tried to push my hand a way, but I kept putting it on her as a security blanket trying to protect her from the world.  Finally, we got our order and made our way back to the car.  When we arrived she started looking through her little purse.  I asked her what she was doing, and she said she wanted to give the sad boy some of her money.  After finding what she needed we walked up to this young man, and she handed him some money.  He looked surprised and elated to see this little girl sharing her money with him. 

Afterwards I praised her for her kindness, and then I asked her how she knew what he had written on his sign.  She said, "Daddy he just looked sad, and I knew if he had a sign he needed some money."  During this whole event I was maintaining an awareness of our surroundings which meant sense, but lost sight of the people in need.  It took a child's heart to reach out and care for another.  It amazes me everyday what that little cutie says and does.  I'm thankful that this world still has the heart of children to teach us how to see and care for the needs of others.

Here are some thoughts for your day.  Take care.  Dave

“All I ever wanted was to reach out and touch another human being 
not just with my hands but with my heart.”
― Tahereh Mafi, Shatter Me

“Too often we underestimate the power of a touch, 
a smile, a kind word, a listening ear, an honest compliment, 
or the smallest act of caring, 
all of which have the potential to turn a life around.”
― Leo Buscaglia

“Self-absorption in all its forms kills empathy, let alone compassion. When we focus on ourselves, our world contracts as our problems and preoccupations loom large. But when we focus on others, our world expands. Our own problems drift to the periphery of the mind and so seem smaller, and we increase our capacity for connection 
- or compassionate action.”
― Daniel Goleman, Social Intelligence: The New Science of Human Relationships 

“Some people think only intellect counts: knowing how to solve problems, knowing how to get by, knowing how to identify an advantage and seize it. But the functions of intellect are insufficient without courage, love, friendship, compassion, and empathy.”
― Dean Koontz

“I believe empathy is the most essential quality of civilization.”
― Roger Ebert

Thoughts for the Day - Finding Your Reason

All of us have a reason for the things we do in life.  We need to live a life with purpose or we most likely will feel unfulfilled.  Therefore, here are some thoughts for your day about going after your purpose.  Take care.


“The purpose of life is not to be happy. It is to be useful, to be honorable, to be compassionate, to have it make some difference that you have lived and lived well.”
Ralph Waldo Emerson

“I want to live my life in such a way that when I get out of bed in the morning, 

“The greatest thing in this world is not so much where we stand as in what direction we are moving.”
Johann Wolfgang von Goethe 

“The purpose of life is not to be happy—but to matter, to be productive, to be useful, to have it make some difference that you lived at all.”
Leo Rosten 

“Lord, when I feel that what I'm doing is insignificant and unimportant, help me to remember that everything I do is significant and important in your eyes, because you love me and you put me here, and no one else can do what I am doing in exactly the way I do it.”
Brennan Manning, Souvenirs of Solitude: Finding Rest in Abba's Embrace  

Finding the Missing Puzzle Piece... 3 Things to Know to Improve Patient Engagement and Outcomes

Today in health care there is such a focus on increasing patient engagement, which is primarily driven by costs.  Cost that are either saved or created by patient behaviors an outcomes.  It has been interesting to watch the various interventions that have been tested in patient environments to try and achieve changing patient behaviors.  Even myself and some others came up with a model a few years back aimed at reducing readmission to the hospital by utilizing a community-based approach similar to when I was a hospice nurse.  Obviously it wasn't viewed as the answer to every one's problems, or I wouldn't be sitting here this morning writing this blog.  I probably would, but at least I'd be doing it sitting on some sandy exotic beach somewhere in the world. :)

Seriously though, even I missed the boat with everything we were trying to accomplish.  Over the past three years I've had the opportunity to own my own business, work in leadership roles, and most recently function as a hospital care manager for the past year.  These different roles have exposed me to working with people in a variety of capacities, and have helped me reevaluate what I thought I knew about health care after 25 years.  What I believe is currently happening in health care that is alienating patients and frustrating people boils down to one issue.  A missing puzzle piece that can help us finally complete our masterpiece.  We have forgotten somewhere along the way that health care and medicine is about treating the human condition.

Each day I walk the halls of a hospital and interact with numerous physicians, other staff, patients, and their families.  Every group is playing a unique role in completing the puzzle that we're trying to build.  The one thing we all have in common, that somehow is being lost in the shuffle is that we all share the same humanity.  We are all people that experience e emotions and feelings, and respond to our environment based on those interactions.  What I've realized in the four walls of that hospital is that we're not dealing with diseases and illnesses, we are dealing with broken people whose bodies have become the physical manifestation of their brokenness.  I'm not trying to be a simpleton or deny my background as a clinician, but trying to shed light on why we might be missing the mark and be continuing to look for that lost puzzle piece.

3 steps we can implement to improve the patient experience and outcomes.

Know the person
All of us are part of some sort of relationship in our life.  How do you cultivate that relationship in the beginning?  We get to know the person.  Isn't that that goal of dating or the basis of building relationships.  We want to know about each.  What makes that other person tick, but why?  Think about the question for a moment as it relates to your own relationships.  We want to improve our interaction with each other.  We want to have a better relationship with our family and our friend because it enriches our lives, and creates joy and happiness.  Why should the interaction with patients be any different.  Aren't we trying to accomplish the same outcome, a better relationship that increases our satisfaction.
How do we accomplish this?  The same way we do in our own personal lives.  We get to know each other, so we can understand how best to communicate and meet each others needs.  What are the tools we use to accomplish this goal?, personality tests, first dates where we ask "what's your favorite color?".  If it works in all those aspects of our lives why can't we use the same approach in medicine?  Aren't we trying to each the same outcome, just with different players?
Therefore, I think to start finding the missing puzzle piece is we need to know what it looks like.  One way we can accomplish that is a method of having patients take a personality test that informs us about their core values, and communication style.  Wouldn't this help us first understand them, and also help us know how we can create a successful interaction.  One tool I came across recently that I thought was very interesting was at - "Huey Me allows you to first assess yourself and then through family and friends, explore why each of us are unique and motivated by specific feelings (motivations) that explain why we do, say and react the way we do to almost everything in life!".  
Know the learner -
The next component of improving patient engagement is understanding how to share information.  Not communicate, but information that we want a patient to retain.  How many of you are good students and how many of your are bad students?  Did the way you were presented information have any impact on how you were able to retain the information as a student?  Do you like to listen to books on tape, or do you prefer to read a book, or do you like to watch a video?  These all represent the very different types of media that enhance learning.  Knowing how someone absorbs information increases the chance of them retaining what we want them to learn  Along with this intervention we have to know their literacy level, so we can present information to their unique level of learning.  Therefore, I believe to improve a patients experience and outcomes we must understand both their learning style and level.
In the book, Understanding Student Learning, Entwhistle and Ramsden (2015) examine the extent to which these learning methods reflected the teaching, assessment and individual personalities of the students involved. The book contains interviews with students, experiments and statistical analyses of survey data in order to identify successes and difficulties in student learning and the culmination of these techniques is a clearer insight into the process of student learning.  Their work proves that helping people learn requires a unique approach that identifies both an individual's preferences for receiving information, and their understanding.  If we are to gain ground in helping patients with compliance, we will need to personalize the patient education experience to better serve our patients in improving their health while achieving our outcomes.

Know the reason -  
Finally, we have to again focus on what I said previously in this post.  Much of what is motivating discussions today in health care has a fiscal foundation.  Either it's about making money or losing money.  Those motives impact the way an organization does business, treats their staff, and ultimately treats their customer. Therefore, if organizations are led by internal motivations, we also need to understand that so are the patients we serve.  Why do they do or don't do things in relation to managing their health?  If we persist in providing a cookie cutter medicine approach, then we should expect to get same results that include not meeting patient's satisfaction with their care while missing the mark on our outcomes.  The only way I see to achieve a change from this direction we're going is to improve patient engagement by knowing the reason behind patient actions.

When your doctor gives you a pill isn't that action based on both his or her schooling, and also clinical studies that have proven using that type of pill is effective in treating your illness?  The answer is a resounding yes whether it's a pill, procedure, or referral to another provider.  There is a reason or evidence for the basis of every clinical action or decision.  If we believe in this approach in supporting patient safety, then why wouldn't we use the same approach in working with patients to achieve better compliance and improve quality of life?

One company that has been successful in this type of approach has been Insignia Health that has licensed the use of the Patient Activation Measure from the inventor Dr. Judith Hibbard who designed the tool from more than a decade of her clinical work.  This tool utilizes 13 statements that are presented to patients, and use their responses to stratify their level of "activation" or their own knowledge, confidence, and ability to manage their own health.  They also have a coaching application that coincides with the survey that allows you to tailor teaching to both the specific disease and their motivation level.  The levels are split into 4 categories of Activation from Level 1 (disengaged and overwhelmed), Level 2 (Becoming aware, but struggling), Level 3 (Taking action), and Level 4 (Maintaining behaviors and establishing new personal goals).  What is impressive about this tool is that it's supported by hundreds of peer reviewed journals, and has been successfully used in huge populations to achieve outcomes and positively change lives.  Now isn't that what it is truly about?
If we are looking to make a difference in the lives of the people we serve, then we need to first remember they are people.  All of us live in the same world, and have the ability to draw on the same type of emotions and perspective to impact our lives.  When we as a health care system understand that we need to Know the person, Know the learner, and Know the reason, then we will be able to develop a means to radically change the face of health care for both patients and the organizations that serve their needs.  Just my two cents.  Take care.