Exam 2 - Ch 5/6 Flashcards
Describe goal setting – what stage, and how many are appropriate
- Breaks down complex behavior changes utilizing small changes to improve on and client is able to take ownership of the goals
- Utilized during contemplation, preparation, and action stages
- 1-3 goals maximum
Define each part of the SMART Goals
- Specific – addresses what, why, when, and how
- Measurable – something that indicates clearly that the goal has been achieved
- Attainable – dependent on their actions, and under their control
- Realistic – something that is reasonable
- Time bound – an end point, or how long to do the behavior
Describe countering
- Technique used to exchange a problem behavior for a healthy response, so there is not a void when an individual stops a behavior outright
- Ex: foods that are acceptable or a healthier alternative: baked chicken in lieu of fried chicken
- Others include active diversions, physical activities, relaxation activities
Describe and list the 3 steps in completing a dietary analysis
1) Food intake data collection – what are they currently consuming
2) Data analysis – comparing to standard or measuring tool to know what needs to be changed
3) Interpretation – what does it mean, what needs to be improved?
Describe food intake data collection
- Collection of client assessment questionnaires, administrative data, medical history, and drug history
- Can include readiness questions, 24 hour recalls, food frequency, usual diet, dietary history interview
- Education interests
- Tailored to specific clientele: low income, pregnancy, pediatrics, disordered eating, gastric by-pass, gym, geriatric, young mothers, weight loss, cholesterol, DM
Describe an options tool
- Write each topic in a circle on paper and leave some blank, ask the client what else needs to be added to help client identify a specific area of focus
- Helps when client is having trouble narrowing in
What are the 6 food management tools?
- Meal replacements
- Detailed menus/meal plans
- Exchange list/CYF
- Myplate
- DASH
- Goal setting
Meal replacements
- effective and successful for weight loss, CVD reduction, and DM.
- Can be used for 1 or more meals/day. Controls portion size and food intake by being simple, clear, and reducing exposure to temptation.
- Less stress, fewer temptations, decreased time thinking about selecting and preparing food
Detailed menus/meal plans
- great for people that like structure, who may be overwhelmed with a new diagnosis, or frustrated by previous attempts.
- Plan should be designed based on food preferences and lifestyle patterns.
- Reduces the stress of making choices – tells them what to eat
Exchange list/CYF
- great for someone who wants structure but also freedom to choose.
- Provide them with meal plan of “how many” and “when.” they will determine which foods fit into the meal plan, allowing for flexibility.
- Ex options: choose your foods-diabetes, healthy food choices – weight loss, appendix C – exchange list.
- organized into 4 main groups: CHO, meat and meat subs, fats, alcohol
- Sometimes too complex for clients
MyPlate
- A website that provides individualized diets that consider age, gender, physical activity that is easy to understand and flexible.
- Helps to balance calories, increase intake of nutritious foods, limit foods with lower nutritional value.
- offers an online nutrition analysis
DASH
- for individuals with high blood pressure, but provides guidance for everyone.
- Easy to understand and flexible.
- Some foods may not be part of usual intake.
- Divided into 7 groups: grains, vegetables, fruits, dairy, protein, oils, legumes seeds and nuts
- Higher in fruit and vegetables, Lower limit of servings for the meat, poultry, and fish group.
- Low sodium intake (1500-2300 mg/day)
Identify behavior change strategies
- ABC’s of behavior (Social Cognitive Theory)
- Cue management (Stimulus control)
- Countering
- Reinforcement: Rewards
- Contracting
- Encouragement
- Goal setting
- Modeling
- Barriers counseling / Problem Solving
- Cognitive restructuring
Define and describe tracking methods and types
Journaling
* Procedures: provide training, use estimates, set meaningful and achievable goals, variety of record keeping, provide non judgy feedback.
* Increase self-awareness and provides a time out for decision making
* Most effective to record immediately before or after eating
* Factors to Consider: Food, Portion size, calories, macros, physical activity, time, place, presence of others, mood, thoughts, concerns, degree of hunger activities, health parameters
* Resistance increases with reqs for entries
* Provide a variety of ways to track
* Always review if them bring their record
Alternatives to Tracking:
* Brainstorm with client, box checking, cards, handheld device, use art, empty bowl, take pictures
Describe and list interactive educational experiences
- Client must get both content and application in education
- Experiences: grocery store tour, cooperative cooking, cafeteria meal, fitness trail walk with topic covered, trip to a gym, practice selecting foods, modified recipes, interpret food labels, create menus, measure/weigh portions, analyze blood glucose, role play
- Effective educational language – make your language neutral instead of using you, say people who…
- Linkage of Education Strategies:
o Knowledge/Beliefs: provide didactic education to increase awareness of risk + benefits.
o Skills: demonstration/ showing how to do a skill. Then let client and correct their errors.
o Intentions: goal setting
o Barriers: problem solving ways to overcome
o Self-Efficacy: help maintain well-being.
Describe several suggestions for nutrition education approaches during counseling
- Avoid technical jargon
- Low literacy material – 8th grade or lower
- Difference between literacy and medical literacy
- Simplify material
- Incorporate self-help materials – workbook activities, web sites, homework
- Repeat the important parts several times
- Limit the number of learning objectives per session – don’t overload patient with info.
- Organize material in a logical manner – the first third of a session has the best chance of being remembered.
- Check for understanding
- Incorporate significant others
- Utilize visuals
- Provide meaningful support – educational handouts.
- Disperse education throughout multiple sessions – don’t give all the info in one session, they probably won’t remember it all.
- Use short stories, analogies, personal accounts, and comparisons.
Describe ABC, Consequences at end of behavior chain. How would you address the antecedent?
- Antecedent:
o Stimulus, cue, trigger.
o Cues that trigger unconscious eating or consumption of large quantities of certain food types.
o It concentrates on: physical ability of foods, social, emotional, psychological
o Strategies: avoiding or altering the cue
o Addressed by pre-arranging the cues and using analogies to help identify issue. - Behavior:
o Response, eating
o It Addresses: act of eating (speed), physical, emotional, awareness, attractiveness
o Strategy: substitute for eating - Consequences:
o Positive reinforces: reward
o Punishment: losing a privilege - Behavior Chain: sequence of events from antecedents to consequences.
Describe contracting
documents an agreement to implement a particular goal
Describe cognitive restructuring
Focuses on identifying irrational thinking and changing it from being destructive to positive self-talk.
* Opportunity thinking (enthused by challenges) vs obstacle thinking (self-pity and difficulty of challenge)
* Three Factors for Dysfunctional Thinking:
Internal Dialogue: self-enhancing messages
Mental Image: accomplishments of an intended task
Beliefs: core beliefs can lead to assumptions that trigger automatic thought
Describe modeling
observe and imitate others
Describe reinforcement
Provides incentives by addressing the end of a behavior chain. Needs to be positive.
Describe countering
exchange healthy responses for problem behaviors (substitutes is most common)
Describe supporting self-care management
- Adherence (active) vs Compliance (passive)
o Cooperative approach – degree to which an individual coincides with objective – preferred adherence - Individualization of Therapy:
o Tailored goals and needs to individual
o Stay positive and incorporate favorite foods - Length and Frequency of Sessions:
o Vary with complexity of dx or issue - Creating a Setting Conducive to Counseling
o Perceptions of quality of care is highly related to adherence – i.e. professional setting + limit distractions. - Nonadherence:
o Accept the motivational level of client and work with them still
o Benefits of a session may not be observable, so don’t stop if you don’t see anything happen
o It takes time to see a change
