5/11/2017

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Welcome to the AODA Webinar

Our presentation will begin shortly. Please make sure your

computer speakers are on and any microphone is muted.

As we move through the presentation, please type any

questions into the chat box. All questions will be answered

at the end of the presentation.

Your CPE certif icate and a short survey will be sent out after

the webinar.

Ideas, Tips, Tools, and Activities to Make

your Nutrition Counseling More Effective

LORENA DRAGO MS RD CDN CDE

WWW.HISPANICFOODWAYS.COM

LORENAMSRD@AOL.COM

“I don’t have t ime t o t each.” By saying you don’t

have t ime t o teach, your only solut ion is more

t ime. Your st at ement stops t he process. But if you ask, “How can I most effect ively and efficient ly

t each in t he t ime I have?” you open yourself t o

t he answ er.

Fran London MS, RN, No Time to Teach: The Essence of Patient and Family

Education for Health Care Providers

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How Do You

AUDIO VISUAL KINESTHETIC

Understanding the Patient’s

Perspective

W hat does the pat ient w ant to know ?

W hat does the pat ient need to know ?

W hat skills does the pat ient need to learn?

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Assessing What Your Patient Wants to Know

What is diabetes? What food changes will I need to make?

Are there any foods I need to add to my diet?Are there any foods I need to stop eating or eat less of ?

Do I have to buy special foods? Do I have to change how I cook?Are there any vitamins I need to take?

Can I drink alcoholic beverages?How long do I have to make these changes?

Where can I get more information? Agency for Healthcare Research and Quality (AHRQ). Questions to Ask your Doctor: Questions are the Answer

Practical Tips for Assessing What

Your Patient Wants to Know

Here are some questions that you may want to talk about

dur ing your meeting with the CDE. Circle the ones that are most important to you

These are some of the common questions that patients

have asked me about this topic. You may have some of the same questions. Here is a list of the most FAQ about X.

Which one do would you like to talk about today ?

Write the questions on a f lip chart/blackboard, or

PowerPoint® presentation. By a show of hands, ask participants to select the top three topics of interest. Select

the questions with the top three votes

Practical Tips for Assessing What

Your Patient Wants to Know

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The aim of t he t ool is t o:

Ascert ain pat ient know ledge of subject

I dent ify know ledge gaps

M inimize t ime spent on a subject that a pat ient may already know

Target t he counseling sess ion t o one t hat is relevant to t he pat ient

Patient Knowledge Tool

Ex plain to the patient why the specific questions are being asked and, most important ly, what will

be done w ith their responses.

Pat ients that understand the context of the quest ion being asked w ill know how to better

respond. Doak, L. Doak C. Teaching Patients with Low Literacy Skills

Patient Knowledge Tool

Tips on How to Ask/Engage Your Patient – Preface with:

“I want to give you information about (insert diagnosis) but I don’t want to take up your time by telling you what you already know. So, I need to ask you a few questions that will tell me what I need to address.”

OR

“I want to use your time efficiently. I don’t want to focus on what you already know about (insert diagnosis). These questions will help me determine what you already know about the topic.”

Patient Knowledge Tool

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Circle the foods that will help you manage your blood glucose and cross out those that will worsen it. If you are uncertain, write a question mark (?) next to the food.

Nopal Orange Alcohol

Beets Bread Grapefruit

Milk Corn Sweet potato

Cheese Nuts Beans

Beef Corn Oil Brown Rice

Carrots Oatmeal Pasta

Eggs Plantain Eggplant

Patient Knowledge Tool

Identifying and selecting foods

Preparing foods

Portioning foods

Measur ing

Weighing

Using the nutrition food label

Comparing and contrasting nutritional value of foods

Arithmetic skills: adding, subtracting, dividing, and multiplying fractions and whole numbers

Creating a meal

W hat skills does the pat ient need to learn?

Patient wants to know:

Are there any foods I need to add to my diet?

Are there any foods I need to stop eating or eat less of ?

Patient needs to know:

Beets/carrots are not loaded with sugar

Plantains are a source of carbohydrate

Nopal’s hypoglycemic effect

Patient needs to learn:

Identify sources of carbohydrate

Identify amount of carbohydrates in foods

Carbohydrate budgeting

Creat ing an Agenda

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Introduce Health & Nutrition Topics

in 3 Steps

W hat are you going to say?

W hat are you going to show ?

W hat are you going to do?

Ask appropriat e quest ions

M ake use of imagery t o describe healt h &

nut rit ion concept s

Explain new concept s us ing appropriat e healt h

analogies

W hat are you going to say?

Recall Quest ions Practical Quest ions

Answered with Information or facts that

are recalled by the

patient

An answer that allows the

patient to use new

information in a

meaningful way in their

own life

Purpose To test patients’

knowledge

To take the patient from

memorization (recall

questions) to personal

application.

W hat are you going to say?

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Recall Questions Practical Questions

Examples What’s a carbohydrate?

Name 3 foods that have

carbohydrate

List foods from highest to lowest in

CHO

Descr ibe how you will change your breakfast to decrease the amount

of CHO

Tell me about how you will increase

the amount of vegetables in your

dinner?

Tell patients how they can use the

information: What do you think is the

best way to add spinach to your

lunch?

From the options I shared with you,

which one do you think you can do

r ight now?

W hat are you going to say?

W hat are you going to say?

CONCEPT WORDS

“Balanced” “Healthy” Diet “Normal Range”

CATEGORY WORDS

“Fats and Oils” “Whole Grains”

VALUE/JUDGEMENT WORDS

“Excessiv e” bleeding, Drink in “moderation”

Exercise “regularly”

Use Captivat ing Imagery

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Use Analogies

Blood Glucose A1c

W hat are you going to show ?

1000 mg Lowers A1c 1%

500 mg NOPALLowers glucose 48mg + 16 mg, 180 minutes post ingestion

http://escholarship.org/uc/i tem/555845bf#page-2

http://w w w .ncbi .nlm.nih.gov/pubmed /20516361

1 cup cooked Nopal

149 mg

1

2

3

1/3

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W hat are you going to show ?

W hat are you going to show ?

Quiz

W hat are you going to do?

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Tamarind WaterFlan

ShrimpBeans

AvocadoOlive Oil Guava Skim milk

Circle the Foods with

Carbohydrate

Chip Method

W hat are you going to do?

Chip Method

W hat are you going to do?

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Patient handout

W hat are you going to do?

Calculate Amount of

Carbohydrate

W hite Rice 1/3 cup

Corn ½ cup

Broccoli – 1 cup

Orange juice – 4

oz.

Apple – 1 small

15 grams

15 grams

10 grams

15 grams

15 grams

TOTAL = 70 grams

Your Meal had 70 g of Carbs

Your budget is 45 grams

What do you need to do?

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Where is the Carbohydrate?

Old fashioned Oats

Barley

Spinach

Cottage cheese

Pork Chop

Banana

Bran Flakes

Broccoli

Sugar-free cookies

K et chup

Balsamic Vinegar

Green Tea

Tuna

Low -fat salad dress ing

Lent il Soup

Chicken Cut let s

W hole-w heat Bread

Low -Carb past a

Where is the Carbohydrate?

Old fashioned Oat s

Barley

Spinach

Cot t age cheese

Pork Chop

Banana

Bran Flakes

Broccoli

Sugar-free cookies

K et chup

Balsamic Vinegar

Green Tea

Tuna

Low -fat salad dress ing

Lent il Soup

Chicken Cut let s

W hole-w heat Bread

Low -Carb Past a

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How do you know your patients know?

TEACH-BACK

•Methods for ensuring that patients understand what you have told them

•Ask patients to explain or demonstrate

Information = Education?

I don’t hear

anything

I said I taught him how to sing, NOT

that he learnedI taught my dog

how to sing

Teach-Back

Using your own words, tell me….

I want to be sure I did a good job of showing you how to use the nutrition label. Can you show me how you will use to calculate __ ?

Can you tell me in your own words how and when you need to use your glucose tablets?

How would you describe your condition to a friend?

Can you show me how many pills you would take each day?

We covered a lot about carbohydrates and I want to make sure I explained things clearly. Can you review what we discussed?

Using your own words, tell me your lunch selections using MyPlate

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Summary

Understanding the patient perspective:

Want to know

Need to know

Has to do

Patient Knowledge Tool

Creating an agenda

Teaching in 3 steps:

Say

Show

Do

Teach-Back

Thank you!!!LORENA DRAGO

WWW.LORENADRAGO.COM

LORENA DRAGO MS RD CDN CDE

WWW.LORENADRAGO.COM

LORENA@DIABETESONTHEWEB.COM

TWITTER: @LORENADRAGO

WWW.FACEBOOK.COM/DIABETESANDNUTRITIONEDUCATION

INSTAGRAM: @LORENADRAGOMSRD

Available @

www.eatr ightstore.org

5/11/2017

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Thank you for attending!

Your CPE certif icate and a short survey will be sent out after

the webinar. We will also include a link to the recording an a PDF of the slides.

If you have questions, please email Carr ie at

info@eatr ightoverseas.org.