Nutrition Care Process & Motivational Interviewing
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Questions and Answers

In the NCP (Nutrition Care Process), which MI (Motivational Interviewing) process aligns with the assessment phase?

  • Engage (correct)
  • Planning
  • Evoking
  • Focus
  • During the diagnosis phase of the NCP, which MI process is most applicable when sharing potential topics to discuss based on the initial assessment?

  • Evoking
  • Planning
  • Focus (correct)
  • Engage
  • Within the intervention stage of the NCP, what is the primary MI process used when a practitioner invites a client to voice their motivations for change?

  • Planning
  • Evoking (correct)
  • Focus
  • Engage
  • During the 'Planning' stage of MI within the NCP, what action exemplifies guiding the client towards devising solutions for barriers to change?

    <p>Collaboratively brainstorming strategies to overcome obstacles. (D)</p> Signup and view all the answers

    In the monitor and evaluation phase of the NCP, which activity reflects the 'Planning' stage of MI?

    <p>Inviting the client to determine appropriate monitoring methods. (A)</p> Signup and view all the answers

    A dietitian is working with a client to establish specific, measurable, achievable, relevant, and time-bound (SMART) goals. Which stage of MI within the NCP does this best represent?

    <p>Planning (C)</p> Signup and view all the answers

    What type of question is most aligned with OARS (Open questions, Affirmations, Reflections, and Summaries) when starting a session?

    <p>Open ended questions (C)</p> Signup and view all the answers

    A 45-year-old woman newly diagnosed with type 2 diabetes attends her first appointment. Which of the following questions, used in the spirit of OARS, would be most effective in initiating a conversation?

    <p>&quot;What are your initial thoughts and feelings about your diabetes diagnosis?&quot; (C)</p> Signup and view all the answers

    A client is hesitant to take iron supplements but wants to increase their iron intake. Following the Ask-Tell-Ask method, what should you do after providing them with a handout about iron-rich foods?

    <p>Inquire about their thoughts on the handout and any questions they might have. (C)</p> Signup and view all the answers

    A patient expresses concern about their weight but also mentions a desire to improve their overall health. What is the most appropriate initial response, according to the principles outlined?

    <p>Explore their interest in learning about health behaviors that contribute to their health goals. (A)</p> Signup and view all the answers

    A client mentions their doctor said their A1C levels are slightly elevated and expresses worry about diabetes. Using the Ask-Tell-Ask method, what is the most suitable first step?

    <p>Ask the client if they would like to know more about how to lower their blood sugars. (A)</p> Signup and view all the answers

    In complex reflections, what is the most important practice for a counselor to adopt when trying to understand a client's underlying feelings?

    <p>Being open to the possibility of being incorrect in your interpretation. (D)</p> Signup and view all the answers

    A person is interested in learning more about reducing sodium in their diet. After you 'Tell' this person about foods that are typically higher in salt and how to reduce sodium in the diet, what’s the most appropriate next step?

    <p>Ask them about their thoughts on this information. (C)</p> Signup and view all the answers

    Why is it important for counselors to reinforce change talk through summaries?

    <p>To provide the client with repeated exposure to their statements. (B)</p> Signup and view all the answers

    A client wants to increase iron intake without supplements. After 'Telling' them about iron-rich foods, they express concern about the cost of some options. What's the most appropriate next step, using Ask-Tell-Ask?

    <p>Reassure them that any increase in iron intake is beneficial, regardless of the source, and explore cheaper options. (C)</p> Signup and view all the answers

    Which of the following questions is most suitable to end a summary, in order to encourage the client to consider their next steps?

    <p>&quot;What do you think you will do next?&quot; (A)</p> Signup and view all the answers

    A client says, 'I want to make some changes to my health but I am confused by all the information online.' Which of the following is the best summary?

    <p>&quot;I am hearing that you want to work on simplifying all this information so that it feels like something you can follow.&quot; (D)</p> Signup and view all the answers

    When using complex reflections, what should a counselor do after offering a reflection to the client?

    <p>Ask for feedback to confirm if the reflection was accurate. (B)</p> Signup and view all the answers

    Which of the following statements best describes the purpose of summaries in counseling?

    <p>To reinforce key statements and ensure mutual understanding. (A)</p> Signup and view all the answers

    Melissa has been having trouble sleeping, and she is your patient. Which of the following questions is most suitable to end a summary, in order to encourage Melissa to consider her next steps?

    <p>&quot;What do you think you will do next, Melissa?&quot; (B)</p> Signup and view all the answers

    In the context of complex reflections, consider a client stating, 'I am snacking a lot at night because I am stressed.' What would be the MOST appropriate next step?

    <p>Reflecting on a possible stressor the client has mentioned, seeking confirmation. (C)</p> Signup and view all the answers

    What is the primary purpose of using the 'DARN CAT' acronym in client sessions?

    <p>To guide the exploration of a client's motivation and potential for change in a person-centered way. (B)</p> Signup and view all the answers

    Which of the following questions aligns with the 'Ability' component of the 'DARN CAT' framework?

    <p>&quot;If you decide to change, how could you go about it?&quot; (D)</p> Signup and view all the answers

    A client states, 'I know I need to exercise more, but I just don't have the energy.' How could you apply the 'Need' aspect of 'DARN CAT' here?

    <p>Ask, 'How important is it for you to have more energy?' (C)</p> Signup and view all the answers

    Which of the following exemplifies an 'affirmation' in the context of OARS?

    <p>A statement acknowledging the client's strengths or positive behaviors. (B)</p> Signup and view all the answers

    A client says, 'I've tried to quit smoking so many times, I don't think I can ever succeed.' Which response below is the BEST example of an affirmation?

    <p>&quot;Despite those setbacks, you are still trying, and your persistence is admirable.&quot; (B)</p> Signup and view all the answers

    What is the core characteristic of a 'simple reflection' in motivational interviewing?

    <p>Repeating or rephrasing the client's statement closely to what they said. (A)</p> Signup and view all the answers

    Client: 'I'm not sure if changing my diet will really make a difference, but my doctor keeps telling me to.' Which of the following responses utilizes a simple reflection?

    <p>&quot;It sounds like you're skeptical about whether a diet change will actually help you.&quot; (C)</p> Signup and view all the answers

    A client expresses, 'I feel overwhelmed by the thought of starting an exercise program.' How might you respond using a simple reflection?

    <p>&quot;An exercise program seems like too much right now.&quot; (D)</p> Signup and view all the answers

    When communicating with someone, what linguistic approach demonstrates respect for their autonomy?

    <p>Employing phrases like 'it's your choice' to affirm their decision-making power. (D)</p> Signup and view all the answers

    What is the primary risk of offering advice without first understanding the other person's perspective?

    <p>It may result in advice that is not suitable or helpful for them. (A)</p> Signup and view all the answers

    Which communication technique is most effective for ensuring someone understands information you've shared?

    <p>Asking them to repeat the information in their own words. (A)</p> Signup and view all the answers

    What should you do to offer alternative solutions to someone without falling into the 'expert trap'?

    <p>Offer them a range of options or ideas. (D)</p> Signup and view all the answers

    What's the purpose of phrases that express collaboration, such as 'We can work together on this'?

    <p>To foster a sense of teamwork and mutual effort. (B)</p> Signup and view all the answers

    In the Ask-Tell-Ask model, what's the benefit of asking 'What do you think about that?' after providing information?

    <p>To gauge the other person's understanding and perspective. (B)</p> Signup and view all the answers

    When attempting to motivate someone, why should commands be avoided?

    <p>They can undermine autonomy and create resistance. (C)</p> Signup and view all the answers

    Before presenting possible solutions, it is important to ask:

    <p>&quot;Would you like to hear some ideas others have used or that might fit for you?&quot; (C)</p> Signup and view all the answers

    Melissa is considering cutting out her afternoon coffee but is worried about productivity. Which stage of change is she MOST likely in?

    <p>Contemplation (B)</p> Signup and view all the answers

    Which statement exemplifies 'sustain talk' in Melissa's scenario?

    <p>&quot;I'm afraid that if I cut out coffee, I won't be productive.&quot; (B)</p> Signup and view all the answers

    Using motivational interviewing, which open-ended question would be MOST effective in exploring Melissa's ambivalence about her coffee consumption?

    <p>&quot;What are the pros and cons of your afternoon coffee consumption for you?&quot; (B)</p> Signup and view all the answers

    In the 'Ask-Tell-Ask' approach, what is the PRIMARY purpose of the initial 'Ask'?

    <p>To gain permission or assess existing knowledge. (D)</p> Signup and view all the answers

    Which 'Tell' statement best exemplifies a neutral way of providing information to Melissa, without pressuring her to change?

    <p>&quot;Sometimes, people find that reducing caffeine in the afternoon helps with sleep.&quot; (A)</p> Signup and view all the answers

    Using the 'Elicit-Provide-Elicit' method, what would be the MOST appropriate way to 'Elicit' information after providing information about the effects of caffeine?

    <p>&quot;What are your thoughts about what I have just shared with you?&quot; (A)</p> Signup and view all the answers

    In what way might Melissa's skipping breakfast be related to her afternoon coffee consumption?

    <p>Skipping breakfast might cause low blood sugar in the afternoon, which she tries to correct with caffeine. (B)</p> Signup and view all the answers

    Which of the following reflects the BEST way to phrase a question when asking for permission to discuss Melissa's caffeine habits?

    <p>&quot;Is it okay if we explore how your caffeine intake may be affecting your sleep and energy levels?&quot; (B)</p> Signup and view all the answers

    Flashcards

    NCP Process

    A structured approach to assessment, diagnosis, intervention, and evaluation in healthcare.

    Assessment Phase

    Includes pre-appointment tasks like reading charts and conducting client assessments.

    Diagnosis Phase

    Identifying issues by discussing topics the client wants to explore further.

    Intervention Phase

    Involves evoking client motivations and planning for change.

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    Monitoring and Evaluation

    Post-intervention assessment of methods and follow-up plans for behavior change.

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    OARS

    A communication technique: Open-ended questions, Affirmations, Reflective listening, Summarizing.

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    Open-Ended Questions

    Questions designed to encourage clients to share thoughts and feelings freely.

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    Client Engagement

    The process of involving the client actively in their treatment and goals.

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    DARN CAT

    An acronym to assess motivation for change: Desire, Ability, Reasons, Need, Commitment, Activation, Taking Steps.

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    Desire

    The wish or longing for change, focusing on what the client hopes to achieve.

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    Ability

    The client's perceived capacity to make a change or difference in their life.

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    Reasons

    The advantages or motivations that drive the client to seek change.

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    Need

    The urgency or importance of the desired change for the client.

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    Commitment

    The intention of the client to act on the desired change they expressed.

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    Activation

    The readiness and willingness of the client to begin the change process.

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    Affirmations

    Positive statements recognizing the client's strengths and encouraging progress toward change.

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    Complex Reflections

    A reflective technique requiring different words to convey a client's underlying feelings or thoughts.

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    Waiting for Response

    The practice of allowing the client to confirm the accuracy of your reflection before proceeding.

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    Change Talk

    Statements made by clients expressing their desire or ability to change.

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    Summarizing

    The process of restating key points in a conversation to reinforce client statements and encourage change.

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    Importance of Summaries

    Summaries help clients hear their own change talk multiple times, reinforcing their motivations.

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    Examples of Summarizing

    Phrases used to confirm understanding of client statements, ensuring clarity in communication.

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    Listening for Change Talk

    The technique of identifying and reflecting the client's motivations for change during sessions.

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    Case Study: Melissa

    An example showing the application of techniques in counseling for sleep troubles.

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    High Salt Foods

    Foods that contain a significant amount of sodium, often processed or packaged.

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    Reducing Sodium

    Strategies to lower salt intake in the diet for better health.

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    Blood Sugar Control

    Methods to manage blood sugar levels, especially for diabetes prevention.

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    Health at Any Size

    The idea that health can be pursued regardless of body weight or size.

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    Motivational Interviewing

    A client-centered counseling style to elicit behavior change by helping clients explore and resolve ambivalence.

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    Stage of Change

    The phase a person is in regarding behavior modification, like Precontemplation, Contemplation, Preparation, Action, or Maintenance.

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    Sustain Talk

    Conversation that indicates a person's reasons for not changing their behavior.

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    Ask-Tell-Ask

    A method in counseling where the counselor asks permission to share information, provides information, and then asks for feedback.

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    Elicit-Provide-Elicit

    An alternative phrasing of Ask-Tell-Ask focusing on engaging the client before and after providing information.

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    Effective Counseling Techniques

    Strategies like reflections, open-ended questions, and affirmations used in motivational interviewing.

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    Listening with Empathy

    The practice of actively understanding and sharing the feelings of another person during counseling.

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    Plain Language

    Using short sentences and familiar words to communicate clearly.

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    Visual Aids Usage

    Using pictures and handouts to enhance understanding and retention.

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    Avoiding Directive Language

    Refraining from words like 'can't', 'must', or 'have to' to promote choice.

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    Teach-Back Method

    A technique to confirm understanding by asking the learner to repeat information.

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    Expert Trap

    The risk of giving advice that may not fit the person's situation.

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    Behavioral Menu

    Offering a range of options instead of a single piece of advice.

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    Respect for Autonomy

    Recognizing and supporting a person's right to make their own choices.

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    Collaborative Statements

    Using warm, encouraging tone to express respect and collaboration.

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    Study Notes

    FNH 345/HUNU: Week 4/5 - Motivational Interviewing Basics Part 2

    • Motivational Interviewing Basics Part 2, February 5th, 2025, Sinéad Feeney, MSc, RD
    • Guest speaker Jessie Newman will join on Friday, Feb 7th
    • Today's outline includes Part 2: Motivational Interviewing Basics and Midterm Review

    The Four Processes of MI

    • Engaging: Building rapport, establishing meeting time, previewing expectations, and determining reason for consultation.
    • Focusing: Guiding client to select discussion topics, offering suggestions, and understanding reasons behind topic selection.
    • Evoking: Identifying and responding to ambivalence, encouraging change talk, assessing readiness to change and transitioning to planning.
    • Planning: Requesting permission before sharing information, offering information using elicitation or asking/telling techniques, setting goals and addressing barriers to change.

    The Four Processes in Practice (Counselling Assignments Part 1 & 2)

    • Counselling assignment Part 1: Engaging - Building Rapport, establishing meeting time, previewing expectations and determining reason. Focusing on identifying the topic of discussion and understanding their reason. Gathering relevant information. Evoking - Identifying and response to ambivalence.
    • Counselling assignment Part 2: Continued evoking, Assessing readiness to change, Transition to planning process. Planning - Asking permission, giving information, setting goals, and addressing barriers.

    How does this relate to NCP?

    • Assessment: Reading the chart, conducts assessment, asking client for questionnaire prior to visit, inquiring reason for visit, and asking about interview expectations.
    • Diagnosis: Asking what changes the client is interested in, understanding consultation reasoning, sharing potential discussion topics based on assessment, and sharing reason for consult if unknown.
    • Intervention: Inviting client's voice regarding motivations for change, finding a successful route toward change, guiding client in devising solutions, and establishing specific goals.
    • Monitor and Evaluation: Determining client's appropriate monitoring methods, setting plans for follow up, and reviewing updates to assist in follow up.

    OARS - How to connect with your clients in Session

    • OARS: Open-ended questions to help clients reflect on their feelings and experiences.
    • Example: Seeing a patient newly diagnosed with type 2 diabetes. Initial open ended question examples are: "What might be an open-ended question you might first say?"

    Open Ended Questions & DARN CAT

    • DARN CAT: Desires, Abilities, Reasons, Needs, Commitment, Activation, Taking Steps — these are components to think about how to encourage change
    • DARN CAT ensures focus is on client's capabilities and aspirations.

    Applying DARN CAT to Your Sessions

    • Desire: Open ended questions explore future desires and goals.
    • Ability: Open ended question explore client's perceived ability to change.
    • Reasons: Open-ended question addresses reasons for wanting change.
    • Needs: Open-ended questions explore client's needs.
    • Commitment: Open ended questions explores client's commitment to change
    • Activation: Open ended questions explores client's activation and readiness
    • Taking Steps: Open-ended questions explores client's potential steps toward change

    OARS: Affirmations

    • Positive statements acknowledging strengths and behaviours leading to positive change
    • Examples: "You have made some big changes in the past," "I know you are anxious, but you have already made important progress" and "You have put a lot of thought into this"

    OARS: Reflections (Simple & Complex)

    • Simple Reflections: Rephrasing or repeating client statements to encourage further thought.
    • Complex Reflections: Using different words to reflect the underlying meaning or feeling behind client statements, requires careful consideration of client context.

    OARS: Summaries

    • Reinforce key change statements. Clients hear the change talk once when they speak, twice when reflected by the counsellor, and again when summarised.
    • Summarize throughout or at end to track key points and ensure proper guidance.
    • Examples include summarising what the client has stated. "Just to make sure I understand, you are saying..." " So if I understand you correctly..."

    Summary Examples

    • Client mentions confusion regarding potential health changes and that it feels overwhelming.
    • Potential summary example: "I hear you on that, it can definitely be confusing when searching online, we can clear that confusion by discussing..."

    Case Study

    • Melissa struggles with sleep and uses coffee to counteract energy crashes, skipping breakfast, worrying about work productivity, and is experiencing insomnia. She is concerned that if she stops supplemental coffee intake her work productivity will suffer.
    • Questions for the case study: What stage of change is Melissa in and what strategies would be suggested for counselling her including identifying whether she is expressing change, sustain, or both. What motivational interviewing techniques and questions could be considered?

    How to use MI in your Sessions: Ask Tell Ask

    • Ask permission or what they know/what they want to know.
    • Tell the necessary information respectfully.
    • Ask again what they have understood.

    Other key aspects of MI

    • Tone is encouraging and expresses respect towards the client including statements showing strength ("You have a large amount of knowledge" ).
    • Statements respect the client's autonomy ("It is your choice").
    • Statements emphasize collaboration ("Let's work together").

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    Description

    Test your knowledge on the integration of the Nutrition Care Process (NCP) and Motivational Interviewing (MI). This quiz covers various phases of NCP and how MI strategies align with each stage, including assessment, diagnosis, intervention, and planning. Enhance your understanding of effective client engagement techniques in nutrition care.

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