THE BHARTI CURRICULUM Bharti Hospital, Karnal

AGENDA FOR TODAY
• • • • • • • Recap Problem solving Rules of counselling Analogy building Insulin education Diet review Quiz

RECAP
• • • • • Feedback forms Diet Exercise Insulin Counselling made simple • Analogy building

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

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

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.Assessment • • • • • Felt needs vs. emotional and financial aspects .

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.Establish your Aim • • • • • Felt needs vs.do not suffer with it • Reduce resistance to HCP • Upgrade acceptance of insulin • Address ‘soft’ concerns • Use appropriate analogies. advice . emotional and financial aspects • Focus on felt needs first • Identify priority areas • Increase awareness by one step at a time • Live with diabetes.

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

Convergence Indication for Felt needs intervention HCP opinion Individual opinion Actual needs Family opinion .

Organ-threatening – 3.Life-threatening – 2.Prioritization • Patient’s needs patient – 1.Quality of lifethreatening HCP surroundings • HCP’s acumen – Ability to intervene – Desire to intervene – Doctor’s wish doctor • Environmental factors .

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

Positive thinking • Diabetes can be defeated • Diabetes is not necessarily a disability • Role models • Success stories • The future is bright Good QoL Avoidance of complications Glycemic control .

MENTAL. EMOTIONAL HEALTH GOOD GLYCEMIC CONTROL BETTER PROFESSIONAL PERFORMANCE GOOD PHYSICAL HEALTH . GOOD QUALITY OF LIFE DIABETES EDUCATION GOOD SOCIAL.CARTWHEEL SATISFACTION.

Secrets of counselling Bull’s eye Practical solutions Break the ice • Simple • Straight-forward • Sustained – Thru’ time – Thru’ staff • ‘Sympathetic’ • Solution.oriented • Short & sweet .

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

ABC ANALYSIS CONSEQUENCE BEHAVIOUR ANTECEDENT .

ABC Analysis • Antecedent • Behaviour • Consequence • Correlate all three • Manage step-wise can do 2 activities Munch snacks Lose control Watching TV .

Consequences Posiitive consequence Effective change creators Immediate results Certainty .

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

Certainty assured Change: Beneficial confident • Benefits should be immediate. assured • Point out immediate benefits • Use help of numbers. certain. labels .

Confidentiality • • • • Physical privacy Social privacy Voice modulation Respect for person’s social beliefs • Assurance of longterm support .

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

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

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

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 .

Types of problems • Skills problem • Motivation problem • Resource problem .

Indigenous competitors harmful neutral beneficial .

Types of feedback • Silence – Reduces confidence and performance in long term • Criticism – Demotivates. Tries to stop undesirable behaviour. tries to incorporate it • Reinforcement – Identifies and encourages positive behaviour . may succeed temporarily • Advice – Identifies positive behaviour.

do not impose it • Describe behaviour.Tips for successful feedback • Specify feedback in relation to behaviour • Appropriate timing: advice before an event. tone. body language • Focus on changeable behaviour • Solicit feedback. do not evaluate or be judgemental • Define impact of a behaviour • Check that message is understood . positive feedback after it • Do not delay reinforcement • Consider the person’s needs • Use calm. unemotional language.

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

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

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

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

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

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

selfpurpose • Self-knowledge • Self-responsibility.Self-development • Meaning of life. choice behaviour • Self-esteem. selfefficacy. selfacceptance • Self-regulation of emotions • Self-control. positive yielding • Mindfulness • Self-transcendence • Motivation . accountability. positive assertion.

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