Nutrition Counselling

Learn about this resource by watching the video below!





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Many pre-internship students and interns feel they lack sufficient knowledge and confidence to conduct a successful counselling session and address all the nutrition questions that may arise during a session. The expectation that we need to be walking encyclopedias and be expert counsellors is unrealistic. More often than not, it is more important to listen to the needs of the client and to acknowledge that their needs were understood than to educate them. The key is to continue to learn, improve and develop as a nutrition counsellor.


Self Reflection Guide


This File is a self-reflection guide designed to empower students and interns in identifying areas of strength and areas for improvement. These questions are also meant to help guide critical thinking about their personal approach, or the process for a particular counseling session. The main intended outcome of this reflection is to pinpoint areas for goal setting. This tool can be used to guide self-improvement, awareness, and identify areas where guidance from preceptors should be sought.

Videos


  • FNH 480 In-Class Presentation on Nutrition Counselling: Q&A Session with Dietitians about Nutrition Counselling
Title: Counselling Skills Educational Session, Date: March 23, 2014, Special Guest Panel: Angela Birnie R.D., Gelina Syfchuck R.D. , Kara Vogt R.D.
In-Class Education Session Panel of Expert Discussion Notes
File:FNH 480 In-Class Education Session Panel of Expert Discussion Notes.pdf


Click on the topic questions below to bring you to the relevant sections in the videos. Unfortunately, the sound quality is not ideal so please turn your device and video volumes to maximum.
How do you deal with personal biases when counselling?
please turn on closed captions ('cc' button) for this video
How do you structure a nutrition counselling session?
Tips for interns and preceptor's expectations of interns in counselling
Comments on the Readiness for Change and Motivational Interviewing techniques



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Topic Specific Counselling Resources

Videos

Bariatric Dietitian Consultation
  • (video) Specialist Bariatric Dietitian speaks to a patient prior to her gastric bypass surgery
Diabetes Consultation
  • (video) Doug Speirs has a consultation with Dietitian Alanna Funk at Youville Diabetes Centre

Books

Nutrition Counseling in the Treatment of Eating Disorders by Marcia Herrin. 2013.
  • Nutrition counselling for eating disorders
Heart to Heart :a Manual on Nutrition Counseling for the Reduction of Cardiovascular Disease Risks by Constance Raab. 1983.
  • A product of a pilot series of nutrition counselling workshops developed collaboratively by the National Heart, Lung, and Blood Institute and the American Heart Association
Nutrition Counseling Skills : Assessment, Treatment, and Evaluation by Linda G. Snetselaar. 1989.
  • Obesity- Psychological Aspects
  • Health Counselling
  • Counselling
  • Food Habits
  • Nutrition
Nutrition Counseling for Athletes: A Crisis Communication Model.
  • Rosenbloom, Christine. Nutrition Today, ISSN 0029-666X, 09/2010, Volume 45, Issue 5, pp. 190 - 195.
  • Nutritional counselling strategies covered including: self-monitoring, problem solving, goal setting, reward establishment, stress management, controlling stimuli, and preventing relapse


Web

Healthlink BC
  • Call 8-1-1 and ask a Registered Dietitian counselling related questions
  • Searching 'counselling' on this website gives some disease specific counselling resources
American Society for Parenteral and Enteral Nutrition by ASPEN
  • Clinical guidelines
  • Information for professionals
Clinical Guidelines for Professionals. by Canadian Diabetes Association
  • Clinical guidelines
  • Resources and handouts

Articles

Nutrition Counseling for Patients With Osteoporosis: A Personal Approach.
  • Counselling specific to osteoporosis cases
  • Includes addressing health beliefs about the disease, explaining the disease process, specific nutrition counselling topics and how to discuss them with a client
Individualizing Nutrition Counseling for Patients with Cancer.
  • Specific precautions to take/techniques to use when counselling cancer patients
Cognitive-Behavioral Therapy and Nutritional Counseling in the Treatment of Bulimia Nervosa and Binge Eating.
  • Janet D. Latner, G. Terence Wilson. Graduate School of Applied Psychology.
  • Discusses ways in which principles of behavior change can be applied to eating disorders by non-Cognitive Behavioural Therapy experts
Three Power Tools in Eating-Disorder Counseling.
  • Using collaborative language and connecting through vocabulary with a patient with an eating disorder (includes patient example)
Insights From Eating Disorder Counseling.
  • Includes case studies and lessons learned from several eating disorder counselling Dietitians
Counseling the Outpatient Bariatric Client.
  • Pre- and post-operative counselling sessions for bariatric surgery candidates
  • Assessing an individuals' unique needs and readiness for change
Focused Approach — Find Success With Client-Centered Counseling.
  • Diabetes management focussed
  • Discusses client-centered counselling techniques and group education
Counseling Tips for Anxious Couples — Diabetes Education Calms Fears and Helps Patients Better Manage the Disease.
  • Discusses how to prevent newly diagnosed diabetes patients and their partners from making unnecessary behavioral and lifestyle changes, quell their fears, and help patients better manage the disease
Double Trouble — Counseling Clients With Diabetes and Celiac Disease.
  • Discusses the unique challenge presented with dual diagnosis and how to approach counselling such patients
Counseling Tips for Newly Diagnosed Heart Disease Patients.
  • Outlines topics to cover in the initial visit with a newly diagnosed CVD patient
Behavioral Theories Applied to Nutritional Therapies for Chronic Diseases in Older Adults.
  • Examples of nutrition interventions grounded in behavioural models (DM, HTN, CVD)
  • Practical applications of behavioural theory in dietary interventions for older adults
  • Offers scripts of questions and talking points representing each theory

Weight Related Counselling

In order to address the complex topic of weight related counselling, we decided to put together the following podcast. We interviewed five experienced local dietitians with a wide range of approaches to weight counselling, to ask them about their perspectives and to share their thoughts and tips for resources they use related to weight counseling.

Please click the link below to listen to the podcast.

[1]

In addition to the interviews, we received several suggested resources from all of the dietitians who helped with this project which are compiled into the PDF in the link below:

File:WEIGHT LOSS COUNSELLING.pdf

To learn more about the dietitians in the podcast please read their bios below:

Gerry Kasten - Many of the listeners will recognize Gerry from courses he teaches in the Food nutrition and health program at UBC. Outside of his time at UBC shaping future dietitians minds, Gerry is a public health and home care dietitian, a community leader and seems to be involved in just about everything related to the profession of dietetics. He has an Honours Diploma in Commercial Cooking and has both a Bachelors and Masters degree in Nutrition and Dietetics.

Emma McCrudden - Our second dietitian is originally from Ireland and Like Gerry, she is also a lecturer at UBC, teaching Sports Nutrition courses in the FNH and Kinesiology departments. Before joining UBC, she completed her Masters in Sports Nutrition and Exercise Physiology and previously worked as a Performance Dietitian with a number of organizations including the English Institute of Sport and the Canadian Sport Institute Pacific. Her work focuses on nutrition-related performance enhancement in sport and she is also the Sport Dietitian for the UBC Thunderbirds Varsity programs.

Kara Vogt - An educator with the UBC Dietetics Program. Prior to taking on a role as an educator, Kara’s dietetic practice included work with a variety of clients, in out-patient, in-patient and residential care settings. Kara has worked with adults and youth in her 10 year career as a dietitian and has special expertise supporting individuals struggling with eating disorders.

Heather Woodward - A clinical Dietitian with the Copeman Healthcare Centre. She completed both a Bachelors of Science in Food, Nutrition and Health at UBC and Exercise and Health Physiology from the University of Calgary. Following graduation Heather completed her dietetic internship with Providence Health Care here in Vancouver.

Emily Zamora - Emily completed a Bachelor of Science in Applied Human Nutrition through the University of Guelph in Ontario and a Masters of Science and dietetic internship through McGill University in Montreal. Emily began her career in Montreal, working as a Clinical Dietitian specializing in obstetrics and diabetes. She then moved to Ontario, where she obtained her Certified Diabetes Educator certification and worked at three Diabetes Education Centres. Emily now lives in Vancouver and works as a casual Clinical Dietitian.

A special thank you to Christine Shaddick, a Registered Dietitian at Copeman Healthcare, who met with our group and provided resources and insight for this project. Additionally, thank you to our Course Instructor and Program Coordinator Karol Traviss for her ongoing support in the project.


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Motivational Interviewing (MI) Techniques

Videos

Motivational Interviewing: Core clinician skills - Introducing OARS
  • OARS (Open Questions, Affirmations, Reflections and Summaries)
Motivational Interviewing: Evoking Commitment to Change
  • In this video clip, the Physician works together with the patient to develop a specific focus
  • The provider does this by asking open-ended questions, providing affirmation, using reflective listening and summarizing for the patients (OARS)
  • He also helps the patient to scale the importance of the issue and the patients confidence level
Motivational Interviewing (MI): Core Concepts Video
  • Expert Motivational Interviewing trainer Cathy Cole discusses the principles and spirit of MI
  • Outlines MI core concepts and techniques and ingredients for change
Motivational Interviewing for Health Issues Video
  • Watch expert Motivational Interviewing trainer Cathy Cole employ specific tools and techniques to help clients fully explore their ambivalence
  • Exploring ambivalence, as discussed in this video, is a critical part of the change process—since it is ultimately their decision whether to change or not
Motivational Interviewing (MI): Building Confidence Video
Motivational Interviewing (MI) for Addictions Video
  • Expert Motivational Interviewing trainer Cathy Cole demonstrates various strategies to address clients' lack of confidence
  • These are two full-length sessions provide viewers an opportunity to see MI in action in diverse settings with clients who lack confidence in their ability to achieve their goals
Motivational Interviewing - Alan Lyme
  • An Example of MI technique
  • Outlines the Clinical Supervisor for the Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program at the Medical Center of Central Georgia

Books

Motivational Interviewing. (3rd ed.) by Miller, W.R., Rollnick, S. 2013.
  • Updates the classic conceptualization of MI and is full of examples of MI in action
  • Covering: MI basics, evoking, engaging, focusing, planning, evaluating
Motivational Interviewing in Health Care: Helping Patients Change Behaviour by Rollnick, Miller and Butler. 2007.
  • Behaviour change and MI
  • Core skills of MI (asking, listening, informing)
  • Putting it all together (integrating skills, includes case examples)
Building Motivational Interviewing Skills by Rosengren, D.R. 2009.
  • Practitioner’s workbook written by master MI trainer
  • Outlines MI skills and techniques
Wellness Not Weight: Health at Every Size and Motivational Interviewing (1st ed.) by Ellen R. Glovsky, PhD, RD, LDN. 2014.
  • MI basics
  • Eating disorders and MI
  • Integrating MI and the non-diet approach to weight loss (Chapter by Molly Kellogg, RD)

Web

Motivational Enhancement Therapy (MET) Manual. by U.S. Department of Health and Human Services
  • Motivational Enhancement Therapy is a strategy of therapy that involves a variation of MI to analyze feedback gained from client sessions.
  • Express empathy
  • Develop discrepancy
  • Avoid argumentation
  • Roll with resistance
  • Support self-efficacy
  • Session structure
  • Practical strategies
Motivational Interviewing Algorithm. by UCLA Center for Human Nutrition
  • MI algorithm

Articles

Toward a Theory of MI
  • Paper discusses the relational and technical components of MI
  • Proposes a theory regarding the manner in which MI impacts behavior change
Motivational Interviewing in Health Settings: a Review.
  • Provides an overview of MI, with particular reference to its application to health problems
Motivational Interviewing — A Unique Approach to Behavior Change Counseling.
  • Outlines the spirit of MI and key elements of the listening style
  • Breaks down MI into two phase
  • Nutrition counselling specific
Motivational Interviewing Strategies and Techniques: Rationales and Examples. by Sobell and Sobell.
  • Outlines rational of different MI techniques (PDF format)
  • Covers specific questions to ask when using MI techniques
Readiness-to-Change Ruler by Adult Meducation.
  • Explains how to use the Readiness-to-change ruler effectively in practice
  • Outlines guiding questions

Online Education

A Taste of Motivational Interviewing.
  • Registered Dietitian and MI Trainer Dr. Ellen speaks about MI techniques (1 hour video)
  • Training opportunities (2 or 3 day workshops, MI training, coaching, and consultations)
Motivational Interviewing: Integrating the Total Diet Approach. by Dairy Council of California.
  • Continuing education credit training module on MI (handout, narrated ppt. and post-test)
Motivational Interviewing. by Motivational Interviewing Network of Trainers (MINT).
  • MI resources for professional use
  • Training and continuing education opportunities (Canada and International)

Course Resources

FNH 480 In-Class Presentation Video
File:FNH 480 MI education session slide.pptx
File:FNH 480 Motivational Interviewing Handout.pdf
Decisional Matrix MI Tool
MI Dietary Improvement in Adolescents - Reading

Additional Course Resources

File:FNH 480 Stages of Change Handout.pdf


Be Prepared

Gather information before speaking to the patient by:
  • consulting with other healthcare professionals
  • thoroughly reading chart notes
  • asking/sharing information during rounds
Make necessary arrangements before speaking to the patient
  • prepare resources
  • book an interpreter if needed
  • ask for food records in advance if possible

Build Rapport

Try your best to:
  • maintain eye contact
  • mirror your client's body posture
  • match the tone, pace and inflexion of your patient's voice
  • use the same words as each other
  • leave silent spaces for patients when they are thinking

Be on the patient's side

  • Respect the rights of well-informed patients to make their own decisions
  • Remind the patient that you are there to help them
  • Be wary of the tone you use, do not make them feel bad or dismiss what the client thinks

Prioritize

  • Identify which information is most important to present to the patient during your limited time together
  • Decide what needs to be explained in person and what the patient can learn on their own time

Watch the video below to see these tips in action:



Tips for effectively communicating with different types of patients from a current RD:

The angry patient

The patient with a language barrier

The patient with multiple issues

The patient that is not adhering to recommendations

Words of encouragement


Useful Links for Healthcare Providers on Coping with Difficult Patients:

Difficult patients: How to Cope with Them

  • This is a nutrition based article with acronyms, examples and advice on how to work with difficult patients.

Frame Work For Answering Client Questions

This info graphic provides a step by step framework to aid in effectively addressing client questions in practice.
















Bedside Counselling: Things to Consider

Considerations in a bedside counselling situation.
























Frame Work For Counselling Around Cultural Dietary Practices

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Summary Of Common Cultural Beliefs, Attitudes & Practices In BC

Disclaimer: This is not a comprehensive list of all cultural practices in BC. Common cultural practices were suggested by a few registered dietitians and dietetic interns (2017). This summary does not suggest that an individual that identifies with a particular culture practices it the same as another individual.
































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Resources For Students

Books

Counseling Tips for Nutrition Professionals by Molly Kellogg. Volume 1 and 2. 2009.
  • Counselling tips 1-25 (V1), 26-50 (V2)
  • Covering a broad scope of nutrition counselling obstacles and techniques (including boundaries, referrals, Motivational Interviewing techniques, tips for new counselling Dietitians)
Nutrition Counseling and Education Skill Development by Kathleen D. Bauer. 2012.
  • Counselling and Education
  • Fundamentals of Food Behavior
  • Understanding an Effective Counselling Relationship
  • Characteristics of Effective Nutrition Counsellors
  • Understanding Yourself-Personality and Culture
  • Understanding Your Client
  • Relationship Between Helper and Client
  • Novice Counsellor Issues and much more
Counselling Skills for Dummies by Gail Evans. 2007.
  • (General, not nutrition specific)
  • Understanding yourself
  • Recognizing your own barriers to listening
  • Structuring a helping conversation
  • Understanding people and problems
  • Handling challenges
  • Case studies and discussions
Basic Nutrition Counseling: Skill Development (2nd ed.) by Bauer and Sokolik’s. 2012.
  • 18 page textbook style workbook with review questions and a practice assignment
  • Outlines: foundations of nutrition counselling and education, food behaviour, counselling relationships and much more
Counselling Skills for Dietitians' by Judy Gable. 2007.
There is a newer Edition (2016) that has more recent research and additional tips regard assertiveness and eating distress.[2] - can be accessed with UBC CWL.
  • A Counselling Approach p. 1
  • The Dietitian as a Skilled Helper p. 3
  • The Relationship Between Dietitian and Patient p. 27
  • The Skills p. 57
  • Making Helpful Interventions p. 86
  • The Patient Interview p. 103
  • Putting It into Practice p. 183
  • Support for the Dietitian p. 214

Articles

Challenges in Nutrition Counseling.
  • Outlines clients expectations for competent counsellors
Nutrition Counseling Self-Efficacy of Registered Dietitians.
  • Describes the self-efficacy of Registered Dietitians in performing various nutrition counselling activities
  • Covers current skills used to enhance the Dietitian-client relationship
Counseling Clients Who Just Won’t Change — RDs Give Sage Advice to Fine-Tune Your Approach.
  • Discuss’ issues involved with patients who are unwilling to make important changes that will benefit their health and well-being including patient readiness and stage of change
  • Strategies that will help you guide clients in the right direction including better listening

Online Education

Nutrition Education + Counseling Skills Module. by Dairy Council of California.
  • Training module designed to strengthen communication skills to help Dietitians and Dietetic Students become more effective educators and counsellors
  • Narrated ppt., chart review activities, case study evaluation of an interview form, online post-test, and short answer scenario questions
source: http://wiki.ubc.ca/Dietetics:Nutrition_Counselling