facilitating change and optimizing health and well...
TRANSCRIPT
Facilitating Change
and Optimizing Health
and Well-being in Diabetics
CDR Kailee Fretland, PharmD, BCPS, NCPS
United States Public Health Service
Clinical Pharmacist, Red Lake Indian Health Service
National Pharmacy and Therapeutics Bemidji Area Representative
Disclosures
• The presenter of this presentation has no financial
disclosures or conflicts of interest.
Objectives
• Define health coaching and motivational interviewing
skills
• Understand the barriers to promoting health and
wellness in our patients
• Discuss how pharmacists can use health coaching
skills to positively impact patient care
Change
“The secret of change is to focus all your energy, not on
fighting the old, but on building the new.” -Socrates-
Health Coaching
Elicits autonomous motivation
Increases capacity to change
Facilitates a change process
Moore, M, Jackson, E, Tschannen-Moran, B. Wellcoaches Coaching Psychology Manual 2nd Edition. Wolters Kluwer. 2016
Expert versus Coach
Expert • Educator
• Authority
• Defines agenda
• Feels responsible for client’s health
• Solves problems
• Focuses on what’s wrong
• Interrupts if off topic
• Works harder than client
• Wrestles with client
Coach • Partner
• Facilitator of change
• Elicits patient’s agenda
• Client is responsible for health
• Fosters possibilities
• Co-discovers the answers
• Learns from patient’s story
• Client works as hard as coach
• Dances with patient
Moore, M, Jackson, E, Tschannen-Moran, B. Wellcoaches Coaching Psychology Manual 2nd Edition. Wolters Kluwer. 2016
Three Coaching Skills
Perceptive Reflections
Open-Ended Inquiry
Mindful Listening
Moore, M, Jackson, E, Tschannen-Moran, B. Wellcoaches Coaching Psychology Manual 2nd Edition. Wolters Kluwer. 2016
Mindful Listening
Show Interest
Observe non-verbal
ques
Avoid Interruptions
Avoid prejudice
Open-ended
Inquiry
Reflect
Summarize
Open-Ended Inquiry
Convert these closed-ended questions to open-ended
• Don’t you think it would be a good idea to quit
smoking cigarettes?
• What have your blood sugars been?
• How many times did you miss your insulin this week?
• Where you able to exercise today?
Perceptive Reflections
• Perceptively paraphrasing and reflecting helps patients react
with a deeper and more emotional response
• Mirroring what was said Simple
• Maximizing or minimizing to evoke disagreement towards change talk Amplified
• Reveal multiple perspectives Double-sided
• Redirect away from resistance-provoking subject Shifted-Focus
Moore, M, Jackson, E, Tschannen-Moran, B. Wellcoaches Coaching Psychology Manual 2nd Edition. Wolters Kluwer. 2016
Perceptive Reflections
• I have tried to lower my sugars, I am eating healthier, walking more
and taking my medications but they are still high.
• Your blood sugars are high even though you are eating healthier, walking more and taking your medications everyday.
Simple
• You are saying that it is impossible to lower you sugars. Amplified
• You are saying that you can’t lower your blood sugars because you have tried everything but you also have said how much better you feel when you eat healthier and walk.
Double-sided
• Although it is important to lower your blood sugars lets talk about the healthy changes you have been making.
Shifted-Focus
Moore, M, Jackson, E, Tschannen-Moran, B. Wellcoaches Coaching Psychology Manual 2nd Edition. Wolters Kluwer. 2016
Motivational Interviewing
“Directive, client-centered counseling style for eliciting behavior change by helping
clients to explore and resolve ambivalence”
-William Miller and Stephen Rollnick-
Engaging Focusing Evoking Planning
Moore, M, Jackson, E, Tschannen-Moran, B. Wellcoaches Coaching Psychology Manual 2nd Edition. Wolters Kluwer. 2016
Barriers
• Distractions
• Fixing
• Stereotypes
• Agenda
• Lack of time
• Environmental
• Ambivalence
• Cognitive
• Access
• Lack of time
Public Health
• Tobacco and Substance Abuse
• Physical Fitness
• Mental Health
• Immunizations
Engaging Focusing Evoking Planning
Chronic Diseases
• Diabetes
• Cardiovascular Disease
Elicits autonomous motivation
Increases capacity to change
Facilitates a change process
“Don’t ask what the world needs. Ask what makes you come
alive, and go do it. Because what the world needs is people who
have come alive.”
-Howard Thurman-