A PRESENTATION ON NUTRITION

COUNSELLING SKILLS

BY
LUKYAMUZI JIMMY
Purpose: Enhance participant’s knowledge and skills towards counselling
and communicating to client’s and caregivers on nutrition improvement

ESTIMATED TIME 180 MINUTES

Introduction: In life situations people need to talk to
others and discuss their ordeals to get solutions and
cope with situations.
During the interaction there should be respect to
the client’s own thoughts, beliefs, and culture.
It does not mean that you tell or advise a client
what you think he/she should do or push him/her
towards a particular action.
WHAT IS COUNSELLING- Is an interpersonalcommunication
through which a person is helped to asses his/her current situation; explore
his/her feelings so as to come up with a solution or cope with the problem.
Counselling therefore involves
•Helping a person share his/her problems by expressing his/her
concerns
•Giving factual information about a problem e.g. health
problems, among other concerns
•Guiding a person through various interventions to life problems
•Exploring possible plans of action to reduce risk or resolve
problems
•Helping a person to make informed decissions
Importance of counselling for nutrition
It helps health workers to understand the feeding practices of the client

It helps in knowing possibilities for food availability and preparation

It helps the client know the what, why the feeding problem and
consequence
Helps in listing actions to overcome or reverse the
problem/challenge
Helps the client have self confidence and trust
The Gather Approach in Counselling
Greet, Ask, Tell, Help, Explain, Reassure/Return/Refer
STEPS IN GATHER APPROACH
1) Great the Client-this builds rapport with the client
• Provide a seat for the client and introduce yourselves
• Discuss status and well being since the last
2) Ask how the client feels about his/her nutritional status and foods
intake
Ask about any symptoms, nutritional problems and concerns.
Carry out a nutrition assessment, if you have not done so already. If
nutritional status has been done, record and shares the results e.g.
(dietary history, current weight or BMI or weight Changes,
Is the client eating enough to provide the additional energy needs?
Eating a balanced diet? Drinking enough clean, safe water? Managing
symptoms using dietary approaches? Adhering to drug food plans?
Identify any nutritional needs. For example, not increasing weight
adequately, not adhering to drug-food plan, needing to use dietary
approaches to manage symptoms
Find out what the client has done in the past to address these problems.
What was his/her success
3) Tell the client about alternative choices to address his/her nutritional
problem(s).Use the counselling cards, choosing the appropriate set of
cards that relate to the problem identified above
• Help the client set nutritional goal(s) to address the nutritional
gap/problem(s).An example of SMART goal is, “ I will increase my
weight by 4kilograms by the end of march.
4) Help the client make informed choices. With the client (and family
members/caregivers), develop approaches/actions to attain the nutrition
goal the client has set. As much as possible, let the client come up with
choices that are practical and relevant to his/her context. Some may include
• Periodically monitor my weight every month to asses whether am meeting my
goal.
• Use the hand out to manage any symptoms that may affect my nutrition/dietary
intake.
• Increase my energy intake by;
Having one extra snack every day
Adding groundnut paste or a spoon of ghee to my evening meals, or
Changing my breakfast from a cup of tea and scones to a mug of porridge made
from fermented millet/sorghum or UNIMIX
Ensure that all my drinking water (including the water I use to mix juice) is boiled
(for at least 8 to 10 minutes, and that I wash my hands before preparing or eating
5) Explain fully the choice(s) the client has made;

• Discuss any barriers the client may have in implementing the

choices he/she has made
•Ensure the client can explain the actions he/she will take. Do
demonstrations if necessary
•Summarize what has been agreed and how it be done ( the
client can do this)
6) Reassure and give a return date for next visit
 Planning the Counselling session
Before the Counselling one should:
1. Ensure he/she has enough time to give the client
2. Have a place where the client will be comfortable discussing issues and where there will be
no intrusions
3. Know and understand the content of the counselling cards
4. Have the following tools/materials in place;
Nutrition and HIV/AIDS counselling cards
Food demonstration models
Functioning and accurate weighing scale
Meal plan/drug-food plan
Guide to calorie intake showing showing different types of carbohydrate/starches, fruits,
vegetables and proteins in the locality
Hand outs and references to give to clients
 Data/information collection forms, tally sheet and referral forms
Register or calendar to record the next appointment for a follow up session with clients, based
on own and client availability

Counselling Skills

Active listening skills

Skills to listen and learn help know the client’s beliefs, level of
knowledge and practices/behaviors during the interaction observe
the client’s body language and facial expressions. Which will tell
you about feelings too.
Non-verbal communication
Non-verbal communication means showing your attitude through
your posture, your expression, everything except through speaking.
Helpful non-verbal communication makes a mother feel that you are
interested in her, so it helps her to talk to you
Non-verbal communication to the client helps him/her to be calm
and be able to listen and interact freely
Tips to ensure helpful non-verbal communication
Sit at the same level and close to the client-Eye contact
Remove any physical barriers such as a desk or folders of papers in your arms
Pay attention to the client, avoid getting distracted, and show you are listening by
nodding, smiling, and other appropriate gestures
Take time without hurrying or looking at your watch
Touch appropriately as culturally accepted
Ask open questions
Ask questions in a way that encourages a client to talk but do not need to ask too
many questions
Open questions generate more information as compared to closed question that
requires simple answers of “yes or no” or “ I don’t know”.
Open questions usually start with “How? What? Where? Why?” for example, “How
are you feeding your baby”
Demonstration 2A: Closed question
Introduce the demonstration: in this demonstration listen to whether the health
worker is asking open questions and how the mother responds
Health worker: Good morning. Are you and your baby well today
Mother: Yes, we are well
Health worker: Do you have any difficulties?
Mother: No
Health worker: Is the baby feeding often?
Mother: Yes

Comment:

The health worker did not learn much and it is difficult to continue the conversation
Demonstration 2B
Introduce the demonstration: in this demonstration listen to whether the
health worker is asking open questions or closed questions and how the
mother responds to the questions
Health worker: Good morning. How are you and your baby today
Mother: We are well
Health worker: Tell me, how are you feeding your baby
Mother: I breastfeed her often with one bottle in the evening
Health worker: What made you decide to give a bottle in the evening?
Mother: My baby wakes during the night, so my milk must not be enou
Comment:
The mother offered information in her reply letting the health worker to lea
1. Reflecting back on and showing interest in what the client says
Reflecting back is making a repeat of the statement made by a client but
in different form without changing the meaning. It is one way to confirm
what the client is meaning. However this can be done in another way by
using responses like nodding, smiling, phrases like “Um Hmm” “or “go
on”
This is to show the client that you understand the client’s situation in the
narration therefore the client is encouraged to give more information
In this demonstration, watch how the health worker is showing that
she/he is listening to the client and if using these skills helps the health
worker to learn more from the client.
Demonstration exercise 3
introduce the demonstration: In this demonstration, watch how the
health worker is showing that she/he is listening to the client and if using
these skills helps the health worker to learn more from the client.
Health worker: Good morning, how are you today?
Client: I am very tired of this endless suffering
Health worker: Oh, dear ( Looks Concerned)
Client: I keep awake all night trying to force my child to eat
Health worker: You keep awake all the night?
Client: Yes, my child has refused all foods only takes sweet drinks
Health worker: Mmm. (Nods)
Client: From the time she fell sick she has refused all foods and he has lost weight
Health worker: Oh, tell me more
COMMENT: Responses such as Oh dear and Mmm show that the health
worker was attentive
2.Emphasize to show understanding of the client’s feelings
To emphasize is to understand one’s good or bad feelings. The
interaction/conversation is focused on the client’s point of view as
opposed to sympathy where focus is drawn to experiences or examples
cited. During the interaction, factual questions may be used to ascertain
the client’s feelings about the situation or circumstance
Demonstration Exercise 4A
Introduce the demonstration: In this demonstration, note if the health worker is
showing empathy
Health worker: Good morning(name). How are you and (child’s name) today?
Mother: (child’s name) is not feeding well for the last few days. I don’t know
what to do
Health worker: I understand how you feel. When my child doesn’t feed I get
worried too. I know exactly how you feel
Mother: What do you do when your child doesn’t feed?
COMMENT: What did you hear? Here focus has moved from the mother
to the health worker. This was sympathy-it did not
Focus on the mother’s feelings.
Let us observe another way of doing this.
Demonstration 4B
Health worker: Good morning Rukia. How are you and Assad today?
Mother: Assad is not feeding well for the last few days and I don’t
know what to do
Health worker: You are worried about Assad
Mother: Yes, I am worried he might be sick because he is not feeding
well.
COMMENT: Here the mother is the focus in the conversation. This
health worker emphasized with the mother by reflecting back on the
mother’s concern of the child’s failure to feed
3. Avoid words which sound judging
Words that may sound like you are judging include: right, wrong, well,
bad, good, enough, properly, adequate, problem
Using judging words makes the client feel that has a standard to reach
or that is not behaving normally
For example: Are you feeding well? Implies that there is a standard to
meet. The client may hide how things are going if she/he feels will be
judged
It is more helpful to use open questions as it allows to generate more
information from the client
Demonstration 5A: Exercises on using words which sound judging
In this demonstration, watch to see if the health worker is using judging
words or avoiding them
Health worker: Good morning. Did you gain enough weight since you
were last weighed
Client: Well, I am not sure. I think so
COMMENT: The health worker is NOT learning anything
Demonstration 5B:
In this demonstration, watch to see if the health worker is using judging
words or avoiding them
Health worker: What was your weight last month
Client: The nurse said I had gained half a kilo
COMMENT:
The health worker learnt what she needed to know without
worrying the client
SKILLS TO BUILD CONFIDENCE AND GIVE SUPPORT
Confidence can help one to carry out her/his decisions and to resist
pressures from other People therefore it is important to build confidence
and give support to clients
1. ACCEPT WHAT A CLIENT THINKS AND FEELS
Accepting is neither agreeing nor disagreeing with the Client’s mistaken
ideas and feelings. This is building the client’s confidence and is
encouraged to continue the conversation in which correct information is
given by the counselor
Demonstration 1A
In this demonstration, note if the health worker is disagreeing,
agreeing or accepting with what a client says
Mother: I give my baby a bottle of formula every evening because
I don’t have enough milk for her
Health worker: I am sure your milk is enough. Your baby does
not need a bottle of formula
COMMENT:
What is the health worker doing? The health worker is
disagreeing or dismissing what the Mother is saying
Demonstration 1B
In this demonstration, watch to see if the health worker is accepting
what the mother says, or disagreeing or agreeing
Mother: I give my baby a bottle of formula every evening because I
don’t have enough milk for her
Health worker: yes, a bottle feed in the evening seems to settle some
babies
COMMENT:
What is the health worker doing? The health worker is agreeing
with a mistaken idea
Demonstration 1C
In this demonstration, watch if the health worker is accepting what the
mother says, or disagreeing or agreeing
Mother: I give my baby a bottle of formuls every evening because I
don’t have enough milk for her
Health worker: I see. You think you may not have enough milk in the
evening
COMMENT
What is the health worker doing? The health worker is accepting
1. Recognizing and praise what is right

Recognize and praise what a client is achieving/doing

right. For example point out the efforts the client is
making to eat and or take the medicine. It is one way of
encouraging the client to continue with the correct or
good practice. For example; “ You have adhered to the
medicine instructions, please continue that way”
2. Give practical help
Giving practical help is one way of emphasizing with the client’s
feelings. Practical help means physical support rendered to a client: For
example assisting; in positioning the baby at the breast, feeding a
patient, providing relief to a discomfort.
3. Provide relevant information using suitable and simple language
Relevant information is the education given to the client in accordance
to the pressing need. This information has to be given precisely using
simple language easily understood by the client
In counselling when providing information, the client’s presented
problems should be prioritized to avoid overwhelming the client
with information which is likely to miss out relevance.