Lab Session 21

Lab Session 21
  • Lab Session 21

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LESSON TITLE: NUTRITION COUNSELING AND DIETARY INSTRUCTIONS (PART 1) LEARNING OUTCOMES: Upon completion of this lesson, the nursing student can: 1. 2. 3. 4.

Discuss what is nutrition education and counseling; Identify ways for an effective counseling; Prepare and develop dietary instructional material/s; and Conduct nutritional counseling for a specific topic previously discussed.

NUR 102: Nutrition And Diet TherapyLaboratory) BS NURSING / SECOND YEAR Session # 21 Materials: Book, pen, notebook, and PowerPoint presentation References: Laboratory Manual For Allied Health: Maria Lourdes Cruz-Caudal (2019) Basic Nutrition and Diet Therapy 2nd C&E Publishing, Inc. ources/NACS-Module-3-Counseling-May2016.pdf

LESSON PREVIEW/ REVIEW (10 minutes) Last session, we tackled about eating right for chronic kidney disease. What are the 5 steps of “eating right” for kidney disease management? Choose and prepare foods with less salt and sodium Step 1: _______________________________________________________________________________________ Eat the right amount and the right types of protein Step 2: _______________________________________________________________________________________ Step 3: _______________________________________________________________________________________ Choose foods that are healthy for your heart Step 4: _______________________________________________________________________________________ Choose foods and drinks with less phosphorus Step 5: _______________________________________________________________________________________ Choose foods with the right amount of potassium

(You can do this activity at home as a written activity. To be checked by the instructor during the face to face interaction) MAIN LESSON (20 minutes) Refer to Laboratory Manual p. 49-50

What is nutrition education? ∙ Nutrition education presents general information related to health and nutrition, often to groups in clinic waiting rooms or community settings. ∙ Educators may be trained counselors or health volunteers who deliver prepared talks on specific topics, often using visual aids. They should encourage clients to ask questions and direct them to additional information as needed. What is nutrition counseling? ∙ Nutrition counseling is a two-way interaction through which a client and a trained counselor interpret the results of nutrition assessment, identify individual nutrition needs and goals, discuss ways to meet those goals, and agree on next steps. ∙ Nutrition counseling aims to help clients understand important information about their health and focuses on practical actions to address nutrition needs, as well as the benefits of behavior change. ∙ Nutrition counselors may be nurses or other facility based providers or community health workers or volunteers.

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What makes counseling effective? Optimal counseling contributes to successful health and nutrition outcomes. Ideally, counseling should be done in a place where the client feels comfortable and has privacy. This may be more challenging in a busy health facility than in a community setting, but adjustments can be made to improve the situation. Counselors should be trained to understand and use support materials such as flipcharts, counseling cards, take-home brochures, data collection forms, and referral forms effectively. Ethical principles for counseling Upholding ethical standards is also essential for effective counseling. 1. Provide accurate information. Clients should be able to trust that counselors’ words and actions are truthful and reliable. 2. Keep client information confidential. Clients need to know that counselors will keep their information confidential except as needed for their treatment or recovery. 3. Respect clients’ autonomy. Clients have the right to make their own decisions without coercion. 4. Keep clients’ interests in mind. Advise them based on professional assessment and offer alternatives if you cannot help them. 5. Do no harm. Avoid any interventions that could harm or exploit clients emotionally, financially, or medically. 6. Be fair. Treat all clients fairly and without discrimination. Respect clients’ rights, dignity, and individual difference. The foundation of effective counseling is asking questions about the client’s symptoms and situation to be able to give appropriate information and support the client to make healthy choices at home. Just telling people what to do does not mean that they will do it, because knowledge is not enough to change behavior. Counselors need to know not only what messages are appropriate, but also how to prioritize those messages depending on clients’ needs and how to deliver them effectively in a short time. This requires practice and experience. Different mnemonic devices have been developed to help counselors remember the steps in counseling and guide sound technique. These can also be used during training role-plays and supervision and mentoring visits. Tips for Effective Counseling • Do more listening than talking. • Ask open-ended questions, not just questions clients can answer with “yes” or “no.” • Repeat what clients say to make sure you understood them correctly. • Show interest in and empathy for clients’ problems and situations. • Avoid judging clients. • Listen to what clients think and respect their feelings, even if information may need correction. • Recognize and praise what clients are doing correctly. • Suggest actions that are possible for clients given their situations. • Give only a little bit of information at a time. • Use simple language. • Give suggestions, not commands. GALIDRAA approach to counseling GALIDRAA has proven effective in many settings and captures the essential elements of effective counseling interactions. It can be adapted as needed for other languages. GALIDRAA Greet the client. Ask him or her to sit down and then exchange introductions to establish a comfortable atmosphere. Ask the client about his or her situation and current practices using open-ended questions and familiar language. Listen to what the client and/or caregiver says. Notice body language, use probing questions, and reflect back what the client says to make sure you understand it correctly. Identify the client’s key problems and help select the most important ones to address. Discuss options, considering what is realistic and using visual materials to engage the client and/or caregiver in discussion. Recommend and negotiate a small, doable action, explaining the rationale and benefits. Ask the client to repeat what he or she understood from the discussion and what action he or she Agrees to try at home. Make a follow-up Appointment and ask the client to repeat the date.

CHECK FOR UNDERSTANDING (10 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 15 minutes for this activity:

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Multiple Choice 1. Nurses are in an ideal position to a. screen patients for risk of malnutrition c. order therapeutic diets b. conduct comprehensive nutrition assessments d. calculate a patient’s calorie and protein needs A ANSWER: ________ Nurses have been identified as being in an ideal position to carry out routine RATIO:___________________________________________________________________________________________ nutritional screening to detect patients at risk of malnutrition _________________________________________________________________________________________________ _______________________________________________________________________________________________ 2. Which of the following criteria would most likely be on a nutrition screen in the hospital? a. prealbumin value c. weight change b. serum potassium value d. cultural food preferences ANSWER: ________ C RATIO:___________________________________________________________________________________________ Weight loss is judged as significant if there is a 5% loss over the course of 1 _________________________________________________________________________________________________ month. _______________________________________________________________________________________________ 3. Patient Sinthia has a question about the cardiac diet the dietitian reviewed with her yesterday. What is the nurse’s best response? a. “ask your doctor when you go for your follow-up appointment” b. “What is the question? If I can’t answer it, I will get the dieting to come back to answer it” c. “Just do your best. The handout she gave you is simply a list of guidelines, not rigid instructions” d. “If I see the dieting around, I will tell her you need to see her.” B ANSWER: ________ The nurse’s best response about Sinthia’s question about the cardiac diet the RATIO:___________________________________________________________________________________________ dietitian reviewed with her yesterday is “What is the question? If I can’t answer it, I _________________________________________________________________________________________________ _______________________________________________________________________________________________ will get the dieting to come back to answer it” 4. Characteristics of successful dieters include all of the following except: a. Maintaining a daily food journal c. Counting calories b. Adhering to a strict eating plan d. Eliminating all carbohydrates from their diets D ANSWER: ________ Along with the above-mentioned characteristics, successful dieters monitor RATIO:___________________________________________________________________________________________ their weight, practice portion control, increase physical activity, and aim for healthy realistic _________________________________________________________________________________________________ weight loss ranging from 10% to 20% of initial bodyweight in a year. _______________________________________________________________________________________________ 5. Motivating clients to participate in health promotion activities requires a variety of appealing strategies such as: a. Adapting the program educational materials to the demographic characteristics of the target audience b. Considering education level of the participants c. Finding convenient class times and locations d. Performing health-risk assessments e. All of the above E ANSWER: ________ Motivating clients to participate in health promotion activities requires a variety of appealing strategies RATIO:___________________________________________________________________________________________ such as Adapting the program educational materials to the demographic characteristics of the target _________________________________________________________________________________________________ audience _______________________________________________________________________________________________ RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________ 2. ANSWER: ________

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RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________ 3. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________ 4. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________ 5. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________ LESSON WRAP-UP (35 minutes) Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track how much work they have accomplished and how much work there is left to do. This tracker will be part of the student activity sheet. You are done with the session! Let’s track your progress.

AL Activity: Group activity 1. For all groups, discuss the instructional materials prepared and developed. (Use table 11-1, pg. 49) 2. Present in the class the instructional materials developed through role-playing, taking into consideration the following pointers: 2.1 clear step by step instructions to ensure that the patient/target client understands the nutritional advice; 2.2 provide pointers to emphasize good food habits, proper nutrition, and foods to avoid/ include; and 2.3 make dietary advice simple, clear, and interesting to convince the patient/ client to follow it. 3. Submit the instructional materials at the end of the laboratory activity.

This document and the information thereon is the property of PHINMA Education (Department of Nursing)

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