Case Studies: Dietician

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Influencing engagement with clients with complex needs.

Experienced clinicians working in Multidisciplinary Teams benefit from the Essential Toolkit Course.

Background: 

16 year old with Bulimia (3 sessions in 4 weeks)
The clinician was able to assist the teenage client to increase her willingness to work on maintaining weight following a rapid loss through reduced food intake and purging. Importance in doing this was initially very low due to the presence of cognitive barriers including unhelpful beliefs and lack of knowledge about what to eat and how much to eat to prevent weight gain. The client moved from purging 2-3 times per day to nil purging after the initial session and improved outcomes on a number of other health factors.

How the clinician used HeathChange® Methodology(HCM): 

"By using the HealthChange Framework, I was able to keep myself on track, and I think I managed to deliver some real patient centred care. One patient left incredibly satisfied with increased confidence to return to his self-managed exercise program with the addition of one new exercise. He gained so much better understanding of how to manage his issues after the consultation with me. I used the menu of choice, then really honed in on his confidence when goal setting. One patient was the anxious talker, all over the place in her thoughts. By suing the Menu of Options, she could identify where she wanted some assistance. Another patient was very defensive, and clearly did not want to be told what he should be doing. By explaining my role, consistently asking his permission and offering choice with phrasing along the lines of "many patients with this condition find this helpful", he started to engage. I also used the Decisional Balance Technique to highlight the implications of no action. By the end of the session, he was leaning forward asking questions about what he could do."

Main Changes to Clinical Practice:

  •  Beginning the consult by explaining her role. Reassured the client that it was her decision to make a change and not the clinician’s.
  •  Identified knowledge gaps that were contributing to low levels of importance and readiness. Acknowledged her fears and concerns about weight gain if she went back to a ‘normal’ diet. Respected her concerns about wanting ‘control’ and discussed options to maintain control, but in a healthy way i.e controlling purges and portioning food rather than avoiding
  •  Used the HealthChange Framework to help the client identify barriers and facilitators for change.
  •  Used a positive tracking strategy (track “purge free’’ days) that impacted positively on motivation and confidence.

What Dieticians are Saying: 

"This workshop opened my eyes to other ways of dealing with patients who I may have labelled (unconsciously or consciously) as difficult, unmotivated.”

The course "provided me with the tools to clearly identify patient readiness to change and meet them where they are which ensures I use my time effectively and don't waste resources.” 

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