DIABETES COUNSELLING

1. THE BHARTI CURRICULUM Bharti Hospital, Karnal

3. RECAP Feedback forms Diet Exercise Insulin Counselling made simple Analogy building

4. Counselling WATER Welcome warmly Ask and assess Tell truthfully Explain with empathy Reassure and return

5. Greetings Be polite Use an appropriate greeting Try to establish a relationship Tailor acc. to age, gender, social status Create eye contact Approp body contact Break the ice

6. 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

7. Establish your Aim 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 Focus on felt needs first Identify priority areas Increase awareness by one 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

8. Felt needs Most Indians enjoy talking about their illnesses, real or imaginary Use felt needs as a catalyst for insulin: the ‘bounce back’ technique Achieve convergence of felt and actual needs

9. Convergence

10. Prioritization Patient’s needs 1.Life-threatening 2.Organ-threatening 3.Quality of life- threatening HCP’s acumen Ability to intervene Desire to intervene Doctor’s wish Environmental factors

11. Education/awareness Increase awareness by one step at a time PRIMARY: diet, exercise, insulin, SMBG, hypoglycemia SECONDARY: dose adjustment, investigations TERTIARY: sick day, chronic complications, personality development

12. Positive thinking Diabetes can be defeated Diabetes is not necessarily a disability Role models Success stories The future is bright

13. CARTWHEEL

14. Secrets of counselling Simple Straight-forward Sustained Thru’ time Thru’ staff ‘Sympathetic’ Solution- oriented Short & sweet

15. Feel the patient’s pulse Put yourself in her/his shoes Be willing to change, improvise, experiment, innovate Develop internal motivation, empathy

16. ABC ANALYSIS

17. ABC Analysis Antecedent Behaviour Consequence Correlate all three Manage step-wise

18. Consequences

19. acCountability Change should be measurable Positive consequences should be countable Benefits should be tangible

20. Certainty Benefits should be immediate, certain, assured Point out immediate benefits Use help of numbers, labels

21. Confidentiality Physical privacy Social privacy Voice modulation Respect for person’s social beliefs Assurance of long-term support

22. Motivation to learn Classical or respondent conditioning Operant conditioning Reinforcement Punishment External expectations Sense of urgency Personal advancement Stimulation

23. Transfer of knowledge Association/analogy building Similarity Degree of original learning Critical/urgent element Culture/society Immediate opportunity Social/peer support

24. Reinforcement Select the behaviour Select the reinforcer Reinforcer should be sought after Immedate reinforcement Behaviour-specific reinforcement Natural reinforcement Negative reinf vs. punishment

25. 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

26. Types of problems Skills problem Motivation problem Resource problem

27. Indigenous competitors

28. 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

29. 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 person’s needs Use calm, unemotional language, tone, body language Focus on changeable behaviour Solicit feedback; do not impose it Describe behaviour; do not evaluate or be judgemental Define impact of a behaviour Check that message is understood

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

31. Resistance ANTI-ANXIETY MEASURES Procrastination Wishful thinking Busy-bee behaviour Resignation Boredom Dependency/decision displacement Religion

32. Resistance POSITIVE DEFENCE MECHANISMS Altruism Humour Curiosity Self-analysis Breakdown of problem Rephrasing/ reprioritization

33. AUTONOMY SUPPORT ASK problems ASSESS needs ADDRESS immediate concerns ARRIVE at agreement ANTICIPATE problems

34. AUTONOMY SUPPORT AMEND accordingly ACCOUNT for plan/work APPRECIATE when due ACCREDIT patient and staff both AUDIT improvement

35. R for return Take home message PROFESSIONAL PERSONAL Feedback please Remain in touch God bless you all

36. Self-development Meaning of life, self-purpose Self-knowledge Self-responsibility, accountability, choice behaviour Self-esteem, self-efficacy, self-acceptance Self-regulation of emotions Self-control, positive assertion, positive yielding Mindfulness Self-transcendence Motivation