If You Must Nag, Nag Well

Chronic disease self-management

Self-management of chronic conditions involves partnerships (you and your loved one, them and their provider) to support sticking to long-term treatments and lifetime wellness behaviors that can improve overall health. This approach typically includes learning, making, and maintaining multiple changes in diet, exercise, and the use of prescribed medications, as well as managing complex communications with family, healthcare providers, and systems (healthcare, financial, insurance, etc.).

How do I avoid being a nag or becoming their 'mother'?

Being a nag or a 'mother' is just as unpleasant as being nagged or mothered! However, you have to give yourself permission to nag sometimes. That is, as long as you're nagging with purpose, not needlessly.

• Empower, don't enable. Enabling is doing something challenging for your loved one while empowering is teaching them to do it for themselves. Live by the watch one, do one, teach one principle, which is applicable to almost every task. Have your loved one watch you do the task, then let them do the task themselves, then have them teach someone else how to do the task - another family member, friend, neighbor, doesn't matter! And don't get frustrated or give up and take over if they don't do it perfectly the first time. Or even the second or the third. When you step in, you enable and take away their power. Be present to encourage.

• Avoid the encouragement trap. The above being said, don't let encouraging become nagging or demanding or forcing in disguise. It's astounding how quickly an encouraging phrase like "You can do it!" turns into "Do it!" because it's used too much. Where "You know what to do" starts to sound and feel like "You don't know what you're doing." Overencouragement somehow changes support into (strong) suggestion, even if the actual words don't change. The tone and meaning and intent behind them do, and it's sneaky. It can happen without your awareness. You believe you're still being encouraging but you're really being bossy and maybe even belittling.

• Trust (and prescribing disability). Although it might feel possible, you do not hold your loved one's entire fate in your hands. In other words, you cannot single-handedly save them any more than you can single-handedly doom them. You have to trust them to be in control to the utmost extent of their abilities, and that they are motivated by their own goal or endpoint to act. One of the worst things you can do to your loved one is chip away at their independence by prescribing them disabilities. In other words, assigning them limitations they don't have.

• Try nagging without words. Mastering this usually takes some time. This is the ability to remind your loved one or demonstrate to them what needs to be done without having to verbalize it. Sometimes without even having to be present. Some examples are:

  • Placing the scale where it will remind them to weigh themselves every morning, such as directly in front of the toilet.

  • Setting alarms (typically on a smart device) that reminds them it's time to take their medications. Same with setting toileting reminders (to avoid incontinence accidents).

  • Pushing their walking aid toward them when they get up and start to walk without it.

  • Setting out everything they need for daily grooming where they can see it and reach it easily, which not only makes grooming easier but reminds them what they're to do.

  • Setting a timer on their TV that turns it off, prompting them to get up and do an alternate activity or alerting them that it's time to go to bed.

  • Leave an item out that will prompt them to take action, like leaving a trash bag on the kitchen counter that reminds them to change and take out the trash.

  • Consider a rewards system for things that need to be done consistently. These generally work, though may or may not work with your loved one. However, it's another option to try and doesn't have to be expensive. You give them a foot massage if they complete their home exercise program every day this week. Arrange for a neighbor to participate in a game of chess or cards if they take all their medications as prescribed. Throw in a pint of their favorite ice cream for making good choices at the grocery. You get the idea.

  • Shorten your suggestions to a simple phrase or a look that reminds them to think about their choices or actions. Something like "Slip and fall" when they don't use their walking aid or need to put slippers on their socked feet or "Extra water pill with that?" when they pile the ham on their lunch sandwich or reach for the salt at a restaurant.

• Chronic disease self-management programs. Self-management education (SME) programs can help your loved one learn skills to manage symptoms of their condition, improve eating and sleeping habits, reduce stress, maintain a healthy lifestyle, and more, in an effort to prevent further progression of disease and improve quality of life. They are inexpensive, often covered by insurance, and are typically conducted with small group meetings, internet-based and mobile health technologies, and printed materials. They are often disease-specific, though some are broad-reaching for anyone who wants to address chronic problems in pursuit of better health. Examples are:

  • Arthritis

  • Lung disease (COPD, asthma)

  • Cardiovascular disease

  • Diabetes

  • The Chronic Disease Self-Management Program (CDSMP) is perhaps the most well-known program.

What does being a nag look like?

• Repeatedly telling your loved one what they need to do, despite the number of times it's already been said.

• Constantly checking in on whether they did it, both verbally and visually.

• Hovering over them until it's done.

• Forcing them to rearrange their priorities to get it done, even if it can actually wait.

• Repeating all the negative things that can happen if it doesn't get done.

What does being a 'mother' look like?

• Invading your loved one's space when not invited or welcomed.

• Making them feel guilty or chastizing them for not doing things that you think need to be done (which often extends beyond their chronic disease management and into their daily living)

• Complaining, or stomping, sighing, rolling your eyes, using exaggerated gestures (like grabbing, flinging, and dropping things), or otherwise making a show of frustration over what you're doing.

• Getting upset when they try to help or do something themselves (and making it known that you're rechecking their work).

• Not letting go - doing everything yourself and leaving nothing for them to do.

Rebellion is real, at any age

• Telling your loved one what to do may work for a while, though eventually, they may not do it simply because you keep telling them to do it.

• Telling your loved one they can't have something or do something, over time, may only make them want it more - and they'll get it or do it, but they'll hide it from you.

• Constantly criticizing or chastizing your loved one can cause them to shut down, withdraw, and make very little effort toward self-management because they start to feel that they're doing it only to please you and not for their own health.

• Learning is not accomplished by force, it's accomplished by choice. Information must be presented in a way that gives your loved one the opportunity to decide how it applies to them, its importance, and what to do with it.

But... I just want what's best for them!

You know this, we know this, they know this. Just keep in mind that it's important to include your loved one in deciding what's best for them, and remain cognizant that what you do for them inspires and supports them doing it themselves rather than simply taking over. Making choices for them isn't the same as helping them make choices.

Again, some nagging is good, when it's used to reinforce positive daily behaviors, but you have to be very observant of your loved one and very self-aware to recognize when you're getting close to crossing a line of defeat - theirs and yours.