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Partnerships for Change
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Partnerships for Change






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Partnerships for Change Partnerships for Change Presentation Transcript

  • Motivational interviewing to help people with diabetes improve their diet.
  • You have diabetes.
  • This is serious! You DOCTOR need to lose weight, clean up your diet, and take these medications every day!
  • WIFE You aren’t supposed to eat that! Give me that cookie!
  • You look sad. Here, have a treat! MOTHER
  • Let’s check your sugar. Oooh, it’s too high! NURSE
  • Why do you have all this junk food in the fridge? NUTRITIONIST
  • Blah, blah, blah, blah, Blah, blah, blah, blah… blah, blah, Blah, blah, blah, blah… blah, blah, blah, blah… Blah, blah, blah, blah, blah, blah… Blah, blah, blah, blah, blah, blah… Blah, blah, blah, blah, Blah, blah, blah, blah… Blah, blah, blah, blah, blah, blah, blah, blah… blah, blah…
  • Leave me alone! I’ll just eat whatever I want.
  • “Diabetic Diet”
  • Basic Guidelines • Eat 3 meals/day • Make your meals balanced • Check your sugar • Know how to handle highs and lows • Learn, learn, learn
  • Let’s choose a time to eat breakfast, lunch, dinner and a bedtime snack.
  • Make every meal a cafeteria meal. You need a protein, whole grains, and a fruit or veg.
  • Check your sugar to find out what you should eat at the next meal.
  • Let’s talk about what to do when your sugar goes too high or too low.
  • Let’s work on getting your A1c below 7.
  • Let’s talk about counseling….
  • Traditional Counseling is counselor-centered. Your doctor says you have high cholesterol. Here’s a meal plan for you to follow. Try to eat less fat and get more exercise, okay? Ummm… okay.
  • Motivational Interviewing is client- centered. I’m really concerned about my blood pressure. It’s hard for me to cut back on salt because it’s the only way I can taste my food. What are the health concerns you might like to discuss today?
  • What is Motivational Interviewing? • Client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence • Developed by Miller in 1983 for treatment of problem drinkers, expanded in 1991 by Rollnick • Can deliver better outcomes, as it increases client’s feelings of self-efficacy and ownership of the problem-solving process
  • The Goal of MI… …to create and amplify discrepancy between present behavior and broader goals.
  • Remember: Ambivalence is normal! Wanna hit McDonald’s I’m trying to watch my for lunch? weight… but I would love a cheeseburger!
  • Consider your definition of motivation. When is a client considered motivated? • When they agree with your view? • When they accept the diagnosis? • When they state a desire for help? • When they show distress, and depend on you? • When they comply with treatment? • When they have a successful outcome?
  • Ask open-ended questions. Ask questions that allow for a wide range of possible answers. The question may seek information, invite the client’s perspective, or encourage self exploration.
  • Ask open-ended questions. In what ways has being overweight caused problems for you?
  • Affirm the person. Say something positive or complimentary to the client. It may be in the form of expressed appreciation, confidence or reinforcement. Comment on the client’s strengths or efforts.
  • Affirm the person. You’re a very resourceful person!
  • Affirm the person. You’ve succeeded I don’t think I can do it. through some difficult changes in the past!
  • Reflect what the person says. Use reflections to capture and return to the client something that the client has said. Reflections can simply repeat or rephrase what the client has said or may introduce new meaning or material.
  • Reflect what the person says. Kind of like a bunch Everyone’s getting on of crows pecking at me about my diet and you, huh? my weight.
  • Summarize perspectives on change. Use summaries to pull together points made by the client throughout the session. This can become the basis for an action plan.
  • Summarize perspectives on change. So you’ve told me that you don’t like being tired all the time from having high blood sugar. And you’ve decided to try to drink more water and less soda. Do I have that right?
  • Ask permission before giving advice. This keeps you from falling into the “expert trap” where patients stop listening because of the experience of being lectured or talked down to.
  • Ask permission before giving advice. If you don’t mind, may I share some information about carbohydrates?
  • Who’s Talking the Most?
  • Ask, “How ready are you?”
  • Healthy change can be bad.
  • Are you wrestling or dancing?
  • Carb Counting Are you good at math?
  • Teaching your patients…. How much do you weigh? Divide by 2.2. Multiply by 30. (or 25 if you’re overweight) Multiply by 30%. Divide by 4. That’s your grams of carbs per day! Divide by 15. That’s your carb servings!
  • Doing the math…. 2000 kcal per day 30% of daily kcal from CHO 600 kcal from CHO CHO 4 kcal/g 150g CHO per day 45g CHO per meal plus 15g CHO snack
  • 15g ?