Required Readings - Midterm 1 Flashcards
Diabetes requires what kind of management?
Self-management, which requires self-management education (SME)
What does SME facilitate?
Individual decision making, improving knowledge, attitudes, self efficacy, healthy behaviours and improved clinical outcomes
Define SME
Systematic intervention that involves active participation of the individual in self-monitoring in health parameters and/or decision making with the application of knowledge and skills
What does evidence indicate about SME?
Advantageous for improving glycemic control, self-efficacy, self-care behaviours and reducing diabetic complications
What are the basic knowledge and skills which encompass SME?
- Monitoring parameters
- Healthy eating
- Physical activity
- Pharmacotherapy
- Prevention and management of hypo/hyperglycemia
- Prevention and surveillance of complications
How can the acquisition of knowledge be augmented in SME?
Through cognitive behavioural interventions
What does CBI involve?
- Cognitive restructuring
- Problem solving
- Cognitive behavioural therapy
- Stress management
- Goal setting
- Relaxation techniques
What does CBI do?
Recognize personal awareness and alteration of thoughts and emotions which are essential for behaviour change.
What interventions appear to be the most effective?
Those that combine knowledge acquisition and self-care management
What can decrease barriers to overall diabetes management?
Effective individual health-care provider education
What can improve glycemic control, lips and BP?
Access to an interprofessional team for diabetes education
What are some traits to address to successfully tailor SME?
- Type of diabetes
- Ability to learn
- Readiness for change
- Cultural and health beliefs
- Literacy level
- Socioeconomic background
How can benefits of SME be sustained?
Through self-management support (SMS)
Define SMS
Strategies that augment an individuals ability to self-manage their diabetes.
How can SMS be delivered?
- Follow-ups
- Diabetes coaching
- Peer support/community health worker
- Support groups
How else could SMS be delivered?
Email, telephone reminders, telehealth, internet
How can SMS be tailored?
- Frequent follow-ups with diabetes educator, which could be done through the telephone.
- Community health worker in ethnically diverse populations
- Diabetes coaching for personalized support
What is the overarching goal of SME and SMS?
Engagement in effective diabetes self-management
What are the 3 key concepts of SME?
- Knowledge
- Skills
- Behaviour
What are the 4 key concepts of SMS?
- Reinforcement
- Coaching
- Peers
- Community
What is a shared concept between SMS and SME? What does it entail?
Patient centered, which must be done interactively
SME is _____ while SMS is _____
collaborative
individualized
What are the two kinds of nutrition interventions delivered by RDs?
Nutrition education and nutrition counselling
What is nutrition education?
Provides the patient/client with information to improve knowledge and skills.
What is nutrition counselling?
Involves more in-depth behaviour change strategies
What two kinds of language is imparted in nutrition education?
1) Instruction/training to develop knowledge
2) Instruction/training to develop skills
What are the 4 key steps in nutrition education? (CPET)
- Clearly communicate
- Prioritize nutrition issue
- Explain relationship of nutrition to diseases
- Tailor education to individual
What is the ultimate goal of nutrition counselling?
For the patient to take responsibility for behaviour that improve their nutritional status to treat the existing condition and improve overall health
What is the principle of cognitive-behavioural theory?
Behaviour is learned and is directly related to both internal and external factors.
Application of CB theory in nutrition?
Focus on interventions which change the environment, and ways to change patterns of negative thinking
Principle of the health belief model?
Predicts a persons decision about health-related behavioural changes and identifies the clients perceived ability to accomplish a behaviour change
Application of health belief in nutrition?
May benefit from explanations of disease risks and link to diet or exploration of pros/cons
Principle of social learning theory?
Builds on concepts of modelling, where people learn through people who are doing well
Application of social learning theory in nutrition?
Share success stories, refer to support groups and engage clients in group classes
Principle of stages of change?
Behaviour change occurs in stages of motivation as client moves through the 5 stages to take action
Application of stages of change model in nutrition?
Tailor treatment interventions to clients stage of change
What are ED’s?
Psychiatric conditions characterized by severe disturbances in eating behaviour that result in significant physiologic impairment and in some instances, death.
What is AN characterized by?
Excessive dieting, severe weight loss and distorted body image with a pathological fear of being fat.
What are the two sub-types of AN?
- Restricting type
- Binge eating/purging type
How do restrictive-type AN lose weight?
Through dieting, fasting, or excessive exercise.
How do binge/purging AN lose weight?
Self-induced vomiting, fasting, excessive exercise, misuse of laxatives, diuretics and enemas
What is the most common binge/purging AN compensatory mechanism?
Self-induced vomiting
Do most patients with AN lose their appetite?
No, they often experience profound hunger
How is bulimia nervosa characterized?
Frequent episodes of binge-eating followed by inappropriate behaviours such as self–induced vomiting to avoid weight-gain.
What is specific about the bulimia nervosa diagnostic criteria?
The episode of binge eating must be characterized by consumption during a relatively short period of time of an amount of large food, and a sense of lack of control
What is important when defining a binge?
Understanding the context in which the food was consumed
When is BN diagnosed?
When binge eating and compensatory behaviours occur at least once per week over a period of 3 months
What does a binge result in?
Shame, unpleasant feelings of fullness and often triggers purging or other compensatory mechanisms
BN patients are often of ____ weight
normal
How is binge eating disorder defined?
Recurring episodes of eating significantly more food in a short period of time than most people would eat, with episode marked by feelings of lack of control.
