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Health education relating to diabetes

Health education relating to diabetes. Ann MacLeod, RN, BScN, MPH. One minute paper. Think of the last time you tried to adopt a healthier behaviour. What motivated you to change? What helped, what hindered?. Levels of Prevention. Primary - before a disease develops

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Health education relating to diabetes

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  1. Health education relating to diabetes Ann MacLeod, RN, BScN, MPH

  2. A. MacLeod. Fall 2002

  3. One minute paper Think of the last time you tried to adopt a healthier behaviour. What motivated you to change? What helped, what hindered? A. MacLeod. Fall 2002

  4. Levels of Prevention • Primary - before a disease develops • Secondary - screening, early identification • Tertiary - preventing more serious complications from an identified condition A. MacLeod. Fall 2002

  5. Stages of Change, Prochaska and DiClemente • Precontemplation • contemplation • preparation • action • maintenance A. MacLeod. Fall 2002

  6. Precontemplation • “ it isn’t that they can’t see the problem, they can’t see the solution” “ I can’t be bothered trying to control my sugars.” • No intention to change behavior • resistance to recognizing or modifying a behavior A. MacLeod. Fall 2002

  7. Patient and Nursing • “eating chocolate is the only pleasure I get” • Patient may feel rebellion, need to share info, demoralized, Dr will not spend time • Work on developing rapport • “tell me about, …” encourage change to talk • give factual, motivating information A. MacLeod. Fall 2002

  8. Contemplation • “Knowing where you want to go but not quite ready” • know problem but not quite made commitment but within 6 months • weighing of pros and cons of problem, impact on others and solutions to it A. MacLeod. Fall 2002

  9. Patient and Nursing • Guilt, profound ambivalence, procrastinator • here are the tools to make it easier for you • provide networking • “ here are the complications of uncontrolled diabetes, but we can help you control them” A. MacLeod. Fall 2002

  10. Preparation • Planning to change in next 30 days • taking some small steps of cutting down behavior, investigating some programs A. MacLeod. Fall 2002

  11. Patient and Nurses • Decision to try on behavior • “ I think I can control my diet, but I don’t know how to give a needle. ” • LOC, self-efficacy, positive reinforcement, follow up visits, tools to help, iron out logistics • “how can I help?” “Can you show me how you use your glucometer and needles?” A. MacLeod. Fall 2002

  12. Research studies • Researchers found that key is timing change to correct stage independent of treatment ie counselling, peer programs • for smoking success (@6mos) was • - precontemplators 22% • - contemplators 43% • - preparation or action 76% A. MacLeod. Fall 2002

  13. Action • Currently, practicing change but transition within last six months • a difficult time as takes energy but self-liberation and autonomy to change lives • “I am really working hard to change” A. MacLeod. Fall 2002

  14. Patient and Nursing • Intense time with new behavior, high risk for relapse • lots of support, external recognition, follow up meetings, behavior change and long term benefits “what things are you seeing different” “ your sugars are being well controlled.” A. MacLeod. Fall 2002

  15. Relapse • “tell me about what happened” • “what were the elements of relapse” • “reflect on what you valued to start in the first place” A. MacLeod. Fall 2002

  16. Maintenance • Work to prevent relapse and consolidate the gains beyond six months of action phase • “I may need some help right now to maintain changes” • development of alternate coping strategies A. MacLeod. Fall 2002

  17. Patient and Nurses • Rewards still very important • “do you find it easier to maintain changes” • “what ways to increase your activity are working for you?” • “ what are your rewards for keeping your sugars regulated?” A. MacLeod. Fall 2002

  18. Important Steps for Change • 1. Clearly assess patient’s stage • Nurse, “Tell me where you are at about dealing with your diabetes.” • 2. Tailor interventions accordingly A. MacLeod. Fall 2002

  19. Enhancing Motivation • Elicit client’s concerns • emphasize personal choice and responsibility for future behavior • treatment goals and strategies are negotiated based on info and acceptability • express and reflect client perceptions A. MacLeod. Fall 2002

  20. Enhancing motivation cont’d • Positive reinforcement • support continued exploration of the problem and solutions • reinforce goal identification and attainment • help pt to move forward “How would like things to turn out for you?” A. MacLeod. Fall 2002

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