Nutr Ed Counsel Module Sep 24

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Nutrition Education & Counseling Skills -- Training Module for Dietetic Students

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  • This training module, Nutrition Education and Counseling Skills contains content and practice activities to help dietetic students and internsmove beyond base knowledge learned in nutrition education and counseling courses to an application level.
  • Upon completion of this module, the learner should be able to:Verbalize an understanding of embedding specific nutrition information in a total diet context.Identify and demonstrate use of dietary patterns as nutrition education tools.Verbalize an understanding of multiple factors influencing clients' and consumers’ dietary decisions.
  • Demonstrate client-centered counseling techniques, such as active listening.Define and demonstrate a guided counseling approach when counseling.Assess a counseling session using the Nutrition Care Process framework.
  • The purpose of nutrition education isto:Help individuals to make well-reasoned food choices and adopt behavior patterns that are sustainable over time. Encourage a balanced, individualized nutrition plan that includes a variety of foods from all food groups.To dispel “good” and “bad” food messages. To discourage extreme dietary restrictions or quick fixes that are short lived.
  • Nutrition education and counseling messages should be developed within the context of the total diet. Based on the position statement of the American Dietetic Association the total diet or overall pattern of food eaten is the most important focus in nutrition education. All foods can fit within this pattern, if consumed in moderation with appropriate portion size, and combined with regular physical activity. It is important to communicate healthful eating messages to the public that emphasize a balance and variety of foods. Messages that focus on any one food, especially labeling a food as “bad” and must never be eaten are unnecessarily restrictive and not sustainable.
  • A directive counseling style can be appropriate in an acute care setting. In this case the registered dietitian uses terms such as, “You should” or “You must”. This style tends to create client resistance so limit this use to only when it is essential, for instance the doctor has ordered a special diet for a specific lab test that will be conducted the following day. In this case, the diet is non-negotiable. A guided style creates a conversation appropriate for openness and behavioral change. This style levels the playing field and lowers the clients resistance by virtue of the counselor using open-ended questions, reflections and assessment of the client interest and confidence in making dietary changes. Examples of open-ended questions are, “What would you like to talk about today?” or “What do you think is your greatest challenge when trying to eat healthy?” Conversation starters such as these cast a broad net and allow the client to give what is most pressing on his or her mind. Motivational interviewing is a guided counseling style to elicit behavioral change by uncovering the client’s internal motivation. Clients are led during the conversation to explore and to resolve any ambivalence they have about changing a behavior.
  • The Dietary Guidelines for Americans are designed to lower the risk of chronic disease and promote wellness. The Guidelines recommend using food patterns such as “MyPyramid” or the DASH diet. Each of these food patterns includes all five food groups. The DASH diet has an additional focus on fruits, vegetables and low-fat dairy foods. Food patterns allow the user to simplify the process of getting adequate nutrients. They also allow for a great deal of flexibility since there are many food options within each food group. They increase the odds of success when working with diverse population groups, specifically by including a variety of commonly available and favorite foods. Using dietary patterns in nutrition counseling has the potential for far-reaching benefits.
  • The second assignment in this module is a case study. In this case study a private practice dietitian has a referral from a local physician. The following information is included in the referral: Jessica is a 16 yrs old white female. She is 5’5” and weighs 125 pounds. She is a competitive swimmer and would like to evaluate her diet in order to improve her swimtimes. She is muscular and there is a family history of type 2 diabetes.
  • For each case study there are two examples of the counseling session. The following is the first example of the dietitian’s interview with Jessica. While listening, use the Case Study Evaluation of an Interview handout. Specifically, listen for client problems and factors that affected food choices and the corresponding dietitian recommendations. Did the dietitian frame the nutrition advice in a total diet context? Did the dietitian use client-centered counseling techniques?
  • Now listen to second counseling session for the same case study and complete the Case Study Evaluation of an Interview handout.
  • Jessica’s existing nutrition problems include her dietary pattern: skipping breakfast, inadequate lunch and large dinner. She also has low nutrient intake due to low consumption of fruit, vegetable and milk. The timing and content of her meals do not adequately fuel her afternoon workout.
  • In this case study you will be writing a PES statement. PES stands for Problem, Etiology, Signs and Symptoms. A PES statement summarizes the nutrition diagnosis and is part of the Nutrition Care Process. The PES statement informs intervention, monitoring, and evaluation. A sample PES statement for this case study is provided here.Signs and symptoms, the last part of the PES statement (preceded by the words "as evidenced by...") are what you are hoping will change based on the nutrition intervention. This should be the focus of your monitoring and evaluation. In the example listed on this slide, you would be monitoring energy level and hunger to determine the effectiveness of the nutrition intervention.  
  • The final step in this activity is to complete a chart note for this client counseling session using the form provided. Write a chart note based on the scenario you feel better illustrates the best practices for nutrition counseling. The Nutrition Care Process and Model (NCPM) is an accurate charting documentation procedure for use in clinical practice. Nutrition Care Process and Model is designed to add evidence-based information to the assessment, diagnosis, intervention, monitoring and evaluation components.
  • Assignment 3 is another case study. In this situation the client is referred to the dietitian working at outpatient clinic of a University Medical Center. Ms. Marco is a 67 year old Latina female. She has elevated LDL cholesterol, low HDL, hypertension, and pre-diabetes. She is married andlives with her husband. She is 5’1”, 167 pounds. Her doctor has referred her for “low-salt, low-cholesterol, low-sugar diet instructions.”For each case study there are two examples of the counseling session. The following is the first example of the dietitian’s interview with Ms. Marco. Use the Case Study Evaluation of an Interview form to evaluate each version of the interview.Specifically, listen for client problems and factors that affected food choices and the corresponding dietitian recommendations. Did the dietitian frame the nutrition advice in a total diet context? Did the dietitian use client-centered counseling techniques?
  • Now listen to a second version of this counseling session
  • Ms. Marco’s existing nutrition issues include her dietary pattern of skipping lunch and eating a poorly balanced dinner. Her snacks provide too many non-nutritious calories, sodium, fat and sugar. She has sub-optimal nutrient intake due to low fruit, vegetable and milk consumption.
  • As you write the chart note for Ms. Marco, identify the signs and symptoms that you will be monitoring for follow up. Remember that you will be tracking the parameters listed after the words “as evidenced by”. Possible outcomes to monitor are lab values, anthropometrics, her diet recall or report of symptoms. A sample PES statement is provided here.
  • The final step in this activity is to complete a chart note for this client counseling session. Write a chart note based on the scenario you feel better illustrates best practices for nutrition counseling using the form provided.
  • Client-centered counseling techniques increase the likelihood that dietary counseling will be effective. Specifically, motivational interviewing is a guided counseling approach which centers on the client and their needs. Registered dietitians should become proficient at counseling techniques in order to be effective nutrition educators.
  • Nutr Ed Counsel Module Sep 24

    1. 1. Nutrition Education & Counseling Skills― Training Module Developed by Dairy Council of California 2010
    2. 2. Learner Objectives Upon completion of this module the learner should be able to: • Verbalize an understanding of embedding specific nutrition information in a total diet context. • Identify and demonstrate use of dietary patterns as nutrition education tools. • Verbalize an understanding of multiple factors influencing clients' and consumers’ dietary decisions.
    3. 3. Learner Objectives • Demonstrate client-centered counseling techniques, such as active listening. • Define and demonstrate a guided counseling approach. • Assess a counseling session using the Nutrition Care Process framework.
    4. 4. Total Diet Approach
    5. 5. Use the best counseling style for the situation  Directive  Guided  Motivational interviewing
    6. 6. Dietary Patterns
    7. 7. Assignment 1: Listen to this Online Narrated PowerPoint Simplistic Nutrition Recommendations: Unintended Consequence www.dairycouncilofca.org/HealthProfessionals/UCcourse/index.htm
    8. 8. Assignment 2: Case Study―Jessica Assessment:  Jessica is 16 yrs old white female  She is 5’5” and 125 pounds  She is a competitive swimmer and has come to see the dietitian to improve her times  She is muscular and there is a family history of type 2 diabetes
    9. 9. Case Study―Version 1  Diet History reveals: o Skips breakfast o Power bar + soda for lunch o Very large dinner While listening, use the Case Study Evaluation of an Interview handout
    10. 10. Case Study―Version 2  Client-centered counseling techniques?  Client problems?  RD recommendations?  Factors affecting food choices
    11. 11. Nutrition Diagnosis Jessica’s current dietary pattern: • skipping breakfast, inadequate lunch, large dinner • low fruit, vegetable, and milk intake • timing and content of meals does not adequately fuel her intense physical activity
    12. 12. Problem, Etiology, Signs & Symptoms  Sample PES statement:  Daily imbalance and inadequate energy/ nutrient intake compared to needs related to no breakfast and poor selections at lunch and high physical activity as evidenced by lack of energy in a.m. and famished after swimming in p.m.
    13. 13. Chart Note Activity  The final step in Assignment #2 is to complete the chart note for this client.  When charting, the Nutrition Care Process and Model (NCPM) is an accurate documentation procedure for clinical practice.  Chart note activity form
    14. 14. Assignment 3: Case study―Ms. Marco  Ms. Marco is a 67 year old Latina female  She has elevated LDL cholesterol, low HDL, hypertension, and pre-diabetes.  She is married and lives with her husband.  She is 5’1”, 167 pounds  Her doctor has referred her for “low- salt, low-cholesterol, low-sugar diet instructions.”
    15. 15. Case Study―Version 1 Diet History reveals: o Skips lunch o Snacks on candies and salted nuts o Pastry and several cups of sweetened coffee daily While listening, use the Case Study Evaluation of an Interview handout
    16. 16. Ms Marco―Scenario 2  Now listen to a second version of this counseling session
    17. 17. Nutrition Diagnosis Ms. Marco’s current dietary pattern: • Skipping lunch, poorly balanced dinner • Snacks providing too many non-nutritious calories, sodium, fat and sugar • Low fruit, vegetable and milk intake
    18. 18. Possible PES Statement ▪ Excessive energy , fat and sugar intake related to nutrition knowledge deficit and undesirable food choices as evidenced by recent 20# weight gain, and elevated fasting blood glucose.
    19. 19. Chart Note Activity  The final step in Assignment #3 is to complete the chart note for this client.  When charting, the Nutrition Care Process and Model (NCPM) is an accurate documentation procedure for clinical practice.  Chart note activity form
    20. 20. Summary • Consider long-term health and wellness • Use a food grouping system • Encourage nutrient- dense foods from all food groups
    21. 21. Summary  Client-centered counseling increases the likelihood that dietary counseling will be effective
    22. 22. Nutrition Education Tools:  MyPyramid Menu Planner  MyPyramid Food Tracking Worksheets  Eat Smart. Play Hard. Healthy Lifestyle  Personal Nutrition Planner
    23. 23. References American Dietetic Association: Nutrition and You: Trends 2008 International Food & Information Council: 2010 Food and Health Survey: Consumer Attitudes toward Food, Nutrition & Health Dairy Council of California Health Connections Newsletter, Dietary Patterns, Spring 2007 Position of the American Dietetic Association: Total Diet Approach to Communicating Food and Nutrition Information Miller WR. (2004) . Motivational Interviewing: preparing people for change. 2nd ed. 2002. http://motivationalinterview.org

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