diabetes counselling

7/31/2019 Diabetes Counselling

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THE BHARTI CURRICULUM

Bharti Hospital, Karnal


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AGENDA FOR TODAY

Recap Problem solving

Rules of counselling Analogy building Insulin education

Diet review Quiz


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RECAP

Feedback forms Diet Exercise Insulin Counselling made

simple Analogy building


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Counselling

WATER

Welcome warmly Ask and assess Tell truthfully Explain with empathy Reassure and return


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Greetings

Be polite Use an appropriate

greeting

Try to establish arelationship Tailor acc. to age,

gender, social status

Create eye contact Approp body contact Break the ice


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Assessment

Felt needs vs. actual needs Prioritization Level of education/awareness Level of acceptance of disease Level of resistance to health care/health care

provider

Level of acceptance of insulin/devices/analogues

Social, emotional and financial aspects


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Establish your Aim Felt needs vs. actual needs Prioritization Level of education/awareness Level of acceptance of disease

Level of resistance to healthcare/health care provider Level of acceptance of

insulin/devices/ analogues Social, emotional and financial

aspects

Focus on felt needs first Identify priority areas

Increase awareness byone step at a time

Live with diabetes,do not suffer with it Reduce resistance to HCP Upgrade acceptance of insulin Address soft concerns

Use appropriate analogies,advice


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Felt needs

Most Indians enjoytalking about their illnesses, real or imaginary

Use felt needs as acatalyst for insulin:the bounce backtechnique

Achieve convergenceof felt and actualneeds


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Convergence

Felt needs

Actual needs

Indication for intervention

Individualopinion

Family

opinion

HCPopinion


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Prioritization

Patients needs 1.Life-threatening 2.Organ-threatening

3.Quality of life-threatening HCPs acumen

Ability to intervene

Desire to intervene Doctors wish Environmental factors

patient

HCP

doctor

surroundings


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Education/awareness

Increase awareness by one step at a time PRIMARY: diet, exercise, insulin, SMBG,

hypoglycemia SECONDARY: dose adjustment,

investigations

TERTIARY: sick day, chroniccomplications, personality development


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Positive thinking

Diabetes can bedefeated

Diabetes is not

necessarily adisability

Role models

Success stories The future is bright

GoodQoL

Avoidance of complications

Glycemic control


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CARTWHEEL

DIABETESEDUCATION

GOOD GLYCEMICCONTROL

GOOD PHYSICALHEALTH

BETTERPROFESSIONALPERFORMANCE

GOOD SOCIAL, MENTAL,EMOTIONAL HEALTH

SATISFACTION,GOOD QUALITY

OF LIFE


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Secrets of counselling

Simple Straight-forward Sustained

Thru time Thru staff

Sympathetic

Solution- oriented Short & sweet

Breakthe ice

Practicalsolutions

Bullseye


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Feel the patients pulse Put yourself in her/his shoes

Be willing to change, improvise,experiment, innovate

Develop internal motivation, empathy


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ABC ANALYSISCONSE-QUENCE

BEHAVIOUR

ANTECEDENT


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ABC Analysis

Antecedent Behaviour Consequence

Correlate all three Manage step-wise

Watching TV

can do2 activities Munch snacks Lose control


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Consequences

Immediate

resultsCertainty

Posiitiveconsequence

Effective change creators


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acCountability

Change should bemeasurable

Positive

consequences shouldbe countable

Benefits should betangible


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Certainty

Benefits should beimmediate, certain,assured

Point out immediatebenefits

Use help of numbers,labels

confident

Beneficial

assured

Change:


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Confidentiality

Physical privacy Social privacy Voice modulation Respect for persons

social beliefs Assurance of long-

term support


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Motivation to learn

Classical or respondentconditioning

Operant conditioning Reinforcement Punishment

External expectations Sense of urgency Personal

advancement Stimulation


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Transfer of knowledge

Association/analogy building Similarity

Degree of original learning Critical/urgent element Culture/society

Immediate opportunity Social/peer support


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Reinforcement

Select the behaviour Select the reinforcer

Reinforcer should be sought after Immedate reinforcement Behaviour-specific reinforcement

Natural reinforcement Negative reinf vs. punishment


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Punishment

Works in short-term Worsens

interpersonal

relationship Poor rapport building Works if patient is of

low IQ/used to

subversience Creates unhappy

working atmosphere


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Types of problems

Skills problem Motivation problem Resource problem


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Indigenous competitors

harmful

beneficialneutral


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Types of feedback

Silence Reduces confidence and performance in long term

Criticism

Demotivates. Tries to stop undesirable behaviour,may succeed temporarily

Advice Identifies positive behaviour, tries to incorporate it

Reinforcement Identifies and encourages positive behaviour


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Tips for successful feedback Specify feedback in

relation to behaviour Appropriate timing:

advice before an event;

positive feedback after it Do not delay

reinforcement Consider the persons

needs Use calm, unemotional

language, tone, bodylanguage

Focus on changeablebehaviour

Solicit feedback; do notimpose it

Describe behaviour; donot evaluate or be

judgemental Define impact of a

behaviour Check that message is

understood


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Resistance

NEGATIVE DEFENCE MECHANISMS Rationalization Intellectualization Complaint creation Passive aggression Reaction formation Displacement Denial [ostrich in sand]


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Resistance

POSITIVE DEFENCEMECHANISMS

Altruism

Humour Curiosity Self-analysis Breakdown of

problem Rephrasing/

reprioritization


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AUTONOMY SUPPORT

ASK problems ASSESS needs

ADDRESS immediate concerns ARRIVE at agreement ANTICIPATE problems


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AUTONOMY SUPPORT

AMEND accordingly ACCOUNT for plan/work

APPRECIATE when due ACCREDIT patient and staff both AUDIT improvement


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R for return

Take home message PROFESSIONAL PERSONAL

Feedback please Remain in touch

God bless you all


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Self-development

Meaning of life, self-purpose

Self-knowledge

Self-responsibility,accountability, choicebehaviour

Self-esteem, self-efficacy, self-acceptance

Self-regulation of emotions

Self-control, positive

assertion, positiveyielding

Mindfulness Self-transcendence Motivation

diabetes counselling

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