What is multicultural awareness?
evaluating our own beliefs and attitudes and become comfortable with differences between our customs and those of our clients
What can ineffective communication lead to?
incorrect diagnoses and non compliance with treatment
When being multiculturally aware what are 3 things that should be considered?
- assume differences until similarities are proven
- emphasize description rather than interpretation of evaluation
- avoid stereotyping
What are 5 ways that cultural communication styles differ?
- voice: rate, pitch, and volume
- eye contact: direct gaze or avert eyes as a sign of respect
- expression: restrained, emotional focus
- speech: slow and soft, loud and fast
- greetings: handshake firm, mild
What is often the cause of confusion and misinterpretation?
gestures, facial expressions, and postures
___ posture is a sign of respect
list the zones that describe spacial relationships.
- intimate zone: less than 18”; very close friends, business handshakes
- personal zone: 18”-4’; when giving instructions or working closely
- social zone: 4-12’; most business interaction
- public zone: greater than 12’; very formal interaction
what is the distance and relationship of the intimate zone?
less than 18”; very close friends, business handshakes
what is the distance and relationship of the personal zone?
18”-4’; when giving instructions or working closely
what is the distance and relationship of the social zone?
4-12’; most business interaction
what is the distance and relationship of the public zone?
greater than 12’; very formal interaction
What should you do when working with clients with limited english skills?
Use common terms and avoid slang, acronyms, and shorthand. use short, simple sentences
Should you always speak directly to the clients?
what is pedagogy?
art and science of teaching; teachers are authority figures
In pedagogy, how are teachers viewed?
What is andragogy?
adults are mutual partners in learning, more problem-centered than subject centered, motivation is more internal than external, self-directed learner
In andragogy, how are adults viewed in learning?
mutual partners in learning
Is andragogy more problem or subject centered?
In andragogy, is motivation more external or internal?
what is the learner like in adragogy?
How do middle and upper income adults consider activities they cant relate to?
a waste of time; they are goal-oriented
what do lower income adults’ interests focus on
costs and traditional food habits; oriented toward present and towards solving current problems
very poor are ___ planners
very short term
when working with adolescents consider ___ and ___
peer pressure; attitudes toward authority
how can you connect with adolescents
relate to their interests
elderly have a ___ attention span
what is needed to maintain interest when working with elderly
audience participation; control questions to stay on topic
elderly prefer what type of material
goals and objectives are based on ___
assessment of client knowledge
what are educational goals
goals set in accordance with the process of learning
what must educational goals be based on
previous learning and the characteristics fo the group being instructed
what do objectives in patient centered counseling include
- increased awareness of diet-related risks
- provide nutrition knowledge
- enhance skills to promote long term changes in intake
- increase confidence for making dietary changes
how should objectives be written
what is is (action), who it is (target), when or time frame, measure of outcome; specific, measurable, attainable, relevant, time bound
what is consonance
a fit between the program and the expected outcomes based on the objectives
what are the steps in content development and evaluation
a. evaluate information available and match it to objectives
b. organize into logical sequence
c. develop lesson plan
d. evaluate what you have developed
what is a lesson plan
written summary of info about a unit of instruction
what are 3 things you need to do in a lesson plan?
- describe all aspects of instruction; include plans for reassessment
- include objectives, content, sequence, activities, time allotted
- provide references, method of evaluation
what does instructional media selected depend upon?
- the teaching goals
- the size of the audience
- the physical facility equipment and time available
- the learning style of the audience
what are different types of instructional media
- posters, slides, movies (assist in oral instruction)
- computers, programmed instruction materials (substitute for instructors)
___ instruction materials are used to learn purely cognitive material; leave instructor more time to develop effective and psychomotor learning
computers and programmed instruction materials
___ is closely linked to planning
budget; all expenses must be accounted for
what must be considered when developing the budget
- project funding
- expenditures to date
- current estimates costs to complete the project
- anticipated profit or loss
what do periodic budget reviews help to control?
resources and adhere to the planning schedule
what is program promotion
informs and educates consumers about the existence of a product or service
what are tools in program promotion
- sales promotion
- personal promotion
- public relations
what is advertising?
purchases print or electronic media; targeted message to carefully defined audience
what is sales promotion?
short term incentives to encourage purchases (coupons)
what is personal promotion?
formal/informal presentations, health fairs, cooking demos, media interview; direct contact provides positive feedback
what are public relations
publicity; organized effort to promoter a favorable image through news coverage
what are the three domains of learning?
what is cognitive learning
aquisition of knowlege or subject matter
what is affective knowledge?
aquisition of attitudes and values
what is psychomotor learning
aquisition of muscular skills (exercise, food prep)
**what is bloom’s taxonomy?
hierarchy of learning; objectives at lower level must be mastered before complex learning can take place; is the level of learning appropriate based on the goups prior knowledge
what is design procedure used for
used to plan theory-based nutrition education
what are the six steps of design procedure?
- decide behavior change goals
- explore determinants of change
- select the theory you will use
- indicate general objectives
- generate plans
- develop education plan
what are behavior modification strategies based on?
a cause-and-effect explanation of behavior
what can behavior modification therapy focus on?
- the cues
- the behavior itself
- the consequences of the behavior
what is an antecedent in terms of behavior modification?
an event or environment that triggers a specific behavior or response (tv commercial advertising food)
what are 3 behavior modification methods?
- positive reinforcement
- avoidance learning
what is positive reinforcement
encourages repetition of a given behavior; should be specific and immediate; meaningful attention from superiors
what is avoidance learning?
learn to escape from unpleasant consequences; avoid future criticism by improving future performance
what is extinction?
reduces undesired behavior; absence of reinforcement following undesired behavior (ignore)–>if extinction is repeated, behavior will eventually disappear
what is the transtheoretical stages of change model
behavior involves series of stages; determine stage to assess readiness to change
what are the stages in the transtheoretical stages of change model?
what is involved in the precontemplation stage of the transtheoretical stages of change model
unaware or not interested in making a change; “i did not know salt had any affect on my blood pressure”
what is involved in the contemplation stage of the transtheoretical stages of change model
thinking about making a change; “i was looking at the salt contents in the foods i have at home”
what is involved in the preparation stage of the transtheoretical stages of change model
decides to change and plans to change; “i bought a cookbook on low salt cooking”
what is involved in the action stage of the transtheoretical stages of change model
tries to make the change; “i removed the salt shaker from the kitchen table”
what is involved in the maintenance stage of the transtheoretical stages of change model
sustains the change for six months or longer; “i found a website that helps me plan family low sodium meals”
in the transtheoretical stages of change model, tailoring the intervention to their ___ is more effective
stage of change
why was the health belief model developed?
developed to explain why people, especially high risk people, fail to participate in programs designed to detect or prevent disease;
what is the health belief model?
a person must perceive the severity and their susceptibility to the threat for the threat to be a behavior-motivating factor
what are the components of the health belief model?
- perceived susceptibility; obesity puts me at risk for heart disease
- perceived impact; heart disease will impede my ability to work
- perceived advantage of change; greater mobility
- appraisal of barriers; i don’t like to exercise
- self-efficacy; I can join the gym clise to work
what is self-efficacy?
conviction that you can successfully execute the behavior required to produce the outcomes
what is diffusion of motivation?
how an innovation, an idea, or a behavior spreads; intervention should be tailored to where they are in this process
what are the categories of diffuse motivation that people fall into?
- innovators; adopt an idea readily usually without input from others
- early adopters; opinion leaders in the community; will-respected
- early majority; cautious in adopting a new idea
- late majority; skeptical, adopt an idea only through peer pressure
- laggards; last to adopt the idea
describe the early adopters category of diffuse motivation
opinion leaders in the community; will-respected
describe the early majority category of diffuse motivation
cautious in adopting a new idea
describe the late majority category of diffuse motivation
skeptical, adopt an idea only through peer pressure
describe the laggards category of diffuse motivation
last to adopt the idea
what are the components of diffuse motivation
motivation ___ transition to new behaviors; key is ___ and ___
eases; success; support
what are some principles of communication
motivation; success and support
- emphasize human factors such as feelings, anxieties, and concerns
- involve the learner in an active way (greatest retention)
- establish rapport
- instruct: prepare, present, try, follow up
- discuss problems descriptively
- offer alternatives
- message should be clear, complete, concise, concrete, and correct
what is clarification
pose a question after an ambiguous client message; used to make previous message explicit
what is active or reflective listening?
paraphrase or repeat back what was just said
in reflective listening, focus on ___ rather than on own personal reactions
thoughts and feelings of others
reflective listening involves absorbing ___ and responding to the person’s ___
what is being said; concerns
a ___ acknowledges that there was a reason for a behavior, indicating that the response from the client was legitimate
legitimation statement; “you have a right to feel upset, anybody would”
a legitimation statement acknowledges that ___
there was a reason for a behavior, indicating that the response from the client was legitimate
what is feedback
info client gives back to you as you are discussing and questioning; lets you know what he knows and what he understands about what you are saying
describe good qualities for an environment when teaching
- psychological: openness, encourage questions, informal, supportive
- physical: comfortable temperature, lighting, chairs; maintain eye contact; free from outside noise
- confidentiality: must be respected
the method of instruction is based on ___
- the siaze of the group
- the educational and motivational aspects of the group’s members
the discussion method of teaching helps learners master ___
higher-level cognitive objectives
describe small group discussion
some lecture plus interaction; beneficial in the clinical setting teacher needs to remain in control; 3-5 people with similar needs; learn from each other
in what setting is small group discussion beneficial
how many people should be in a small group discussion
what is a large-group lecture
one way flow of information; presents a large amount of material in a short time
what is group process or group dynamics?1
skills to develop a group leader;
- relieve social concerns
- tolerate silence
- guide and encourage interactions
- know when and how to resume control
- reinforce “multi-sided” nature of conversation
- halt side convos by engaging the distractors
- help group stay on topic
- negotiating techniques
what are negotiating techniques
- plan strategy in advance; know what you are willing to accept
- don’t start with the hard issues; be direct, clear, calm, patient, and tolerant
what is synergy
the groups product (decision) is superior to what the most resourceful individual within the group could have produced by working alone
interviewing requires strong ___ and ___ skills
listening and verbal communication
what are the steps for interviewing
- establish rapport
- collect data
describe the preparation step of interviewing
collect background information- age, weight, height,diet history and establish objectives for collecting info during the interview. CLEARLY DEFINE THE PURPOSE
describe the collect-data step of interviewing
use open-ended, non-judgmental questions
what are open ended questions
broad, gives freedom in responding; gives you a chance to listen and observe takes more time but less threatening
what are closed questions
more restrictive; limits answers gives you control; less time
what are primary questions
introduces new topics
what are secondary questions
follow up; obtain more info
what are neutral questions
preferred; do not reveal your bias
what are leading questions
reveals your bias
what is a funnel sequence
begin with broad open questions and process to more restrictive ones
describe the closing step of interviewing
summarize for the client to check accuracy; tell client what will be done with info; when he will be contacted for teaching
what are 3 forms of nonverbal communication
- kinesics - physical communication
- paralinguistics - how the client’s message is delivered
- proxemics - personal space
what is kinesics
- direct eye-contact- attentiveness
- lowering eyes, look away - preoccupation
- arms folded across chest - dislike, avoidance
- clenched fists - anxiety, anger,
- crossing and uncrossing legs - anxiety
what might direct eye contact mean?
what might lowering eyes, looking away mean?
what might arms folded across chest contact mean?
what might clenched fists mean?
what might crossing and uncrossing legs mean?
what is paralinguistic
how the client’s message is delivered;
- hesitations, stuttering: sensitivity, anxiety
- whispering: difficulty in disclosing
what might hesitations, stuttering mean?
what might whispering mean
difficulty in disclosing information
what is proxemics
- moves away: discomfort
- moves closer: seeking more interaction
- sits behind or next to an object: seeks protection
what might moving away mean
what might moves closer mean
seeking more interaction
what might sitting behind or next ot an object mean
what is the ethical principle of autonomy?
respect other’s right to self-determine a course of action or support of independent decision making
**What are 5 possible counselor’s responses to a client?
**Describe the evaluation response to a client.
make judgement about persons feelings, leads to offering of advice, not problem-solving, seldom helpful “if you eat too much ice cream, i suggest you stop buying ice cream”
**Describe the hostile response to a client.
uncontrolled anger; may antagonize or humiliate client “maybe you are not losing weight because you are not trying hard enough”
**Describe the reassuring response to a client.
may make it difficult to solve the client’s problem or discuss it further. client is prevented from working through feelings “don’t worry about making changes…it just takes time”
**Describe the probing response to a client.
attempt to clarify or gain more information; “can you tell me more about that”
**Describe the understanding response to a client.
one of the best ways to respond, try to recreate the persons message in your own frame of reference. may lead to more client cooperation, helps client feel accepted and safe in expressing their feelings “you seem to be saying that you are feeling…”
What is cognitive behavior theory?
focuses on identifying behaviors and thoughts that have a negative impact on desired behaviors and goals and apply strategies to change those
what does motivational interviewing help clients do?
recognize and begin to resolve their concerns and problems
what is the goal of motivational interviewing?
to increase motivation so that clients are able to express the rational for the changes that need to be made; people make behavioral changes only when they are ready
expressing empathy suggests what to the client
what should you do with resistance
roll with it; acknowledge reluctance to change and ambivalence; offer new information or alternatives to consider
how can you support self efficacy
reinforce hope and optimism
what does client autonomy mean in motivational interviewing
decisions are left to the client even though you may have different opinions
what are 3 methods of communication?
- media activities
written communication is more ___ and ___
written communication is interpreted more ___ and used when ___ is requires
**Keep reading level of materials around the ___ grade for general population and the ___ grade for audiences of lower literacy.
what is the SMOG index
a procedure for determining readability; gives grade level; finds the average number of polysyllabic words
what are examples of written communication
emails, pamphlets, posters, handouts
oral communication is more ___ and encourages ___ communication
what is the most critical barrier of oral communication
poor listening skills
what is the benefit of developing media partnerships with local tv and radio stations
extends reach to audiences that maybe out of reach due to financial reasons
if using the media to introduce a campaign to the community , develop ___ to serve as focus
2-4 key messages
how can you sustain ongoing media relationships
offer to serve as a resource for a few key reporters who cover food or health issues
which step(s) should be evaluated in the educational process (assessment, planning. implementation and evaluation of outcomes)
**What are the 2 types of evaluation of educational outcomes?
**What is formative evaluation?
made during the course of education
a. helps pinpoint parts mastered and parts not mastered
b. allows for revision of plans, methods
c. answers “how should we do it?”
d. client must be involved
e. frequent feedback guides the rest of the educational process
**Should the client be involved in formative evaluation?
yes, they must be; ex. focus group, pre-test
**What is summative evaluation?
designed at planning stage but conducted at end ex post test
a. considered final
b. did we achieve what we planned?
c. have client perform a task using new information
**Summative evaluation is considered ___
final; purpose may be grading or evaluation of progress
when are evaluation strategies developed
once objectives are established
what is are two kinds of formal evaluation
- objective test: not well suited for clinic or community setting
- performance test: client asked to complete task based on learning objectives
is an objective test suited for clinic setting? community?
what is a performance test?
client is asked to complete task based on learning objectives
is an objective test formal or informal?
is a performance test formal or informal?
what is informal evaluation?
unstructured observation of food selection and behaviors
what are 6 questions that can be asked to evaluate the effectiveness of educational plans?
- did it alter patient knowledge, behavior, or attitude?
- what is rate of lapse or relapse?
- timeliness, appropriateness, accuracy? within budget?
- meet specific targeted needs? quality of presentation?
- were processes and outcomes documented?
- what was the degree of growth?
___ of employee education and training is essential
documentation of employee ___ and ___ is essential
education and training
for employees, use ___ checklist; note ___ and ___ of training
orientation; date; content
what is nutritional informatics
the intersection between nutrition, information, and technology; use of technology in spreading information
what are electronic health records
EHR or electronic medical record (EMR); enter, store, retrieve and manage information related to health care
What is a personal health record
PHR; used by consumer to maintain health information
what is HIPAA
maintains privacy of personal health information (PHI)
must a patient be notified if their medical information is to be shared outside of the care process, or if protected information (address, email, income) is to be shared?
what is the patient centered medical home?
PCMH; focuses on the relationship between the patient and their personal physician; the physician takes responsibility for all aspects of the health care for the patient and coordinated and communicates with other providers as needed
in PCMH, is specialty care is needed, who is responsible for ensuring that the transition is seamless
what are telehealth services?
use of electronic information and technologies to support long-distance clinical health care, patient and professional education, public health administration, remote patient face-to-face services, via live video conferencing, store and forward telecommunication services which can then be retrieved by another site for clinical evaluation
what are home telehealth services?
check on symptoms and measure vital signs in the home
what is reimbursement like for telehealth services
it varies among payers; each payer determines the current procedural terminology (CPT) codes they will recognize for reimbursement
what does health coaching use?
uses behavior change models and motivational interviewing (MI); often involves some form of telehealth
what is telenutrition?
rdn uses electronic information and technologies to implement the NCP with clients at remote location within provisions of their state license as applicable. Medicare part B allows some services provided by RDNs to be offered via telehealth including MNT and diabetes self management training
___ allows some services provided by RDNs to be offered via telehealth including MNT and diabetes self management training.
Medicare part B
what tracks nutrition care outcomes and advances evidence-based nutrition practice research
academy of nutrition and dietetics health informatics infrastructure (ANDHII)
what aggregates anonymous data available for outcomes research?
dietetics outcomes registry (DOR)
what is altmetrics?
presentation of amount of activity from twitter, facebook, science blogs, mainstream news and other sources over time
what is the a major usda national nutrient database for standard reference source of?
what is a major source of food composition?
usda national nutrient database for standard reference
what is the food and nutrient database for dietary studies (FNDDS) used for?
analyze data from dietary surveys
what does the FDA total diet study database have data on?
foods minerals and chemical
who is in control of the dietary supplements database
what are 4 food and nutrient analysis software and databases?
- usda national nutrient database for standard reference
- food and nutrient database for dietary studies (FNDDS)
- FDA total diet study database
- dietary supplements database
what are some food and nutrition management software designed for institutional use
- dietary manager
the ___ branch may introduce and enact a law and can override a veto by the ___ branch
legislative (congress, senators, representatives); executive
the ___ branch may veto legislation or sign it into law
the ___ may discard a law if it considers it in violation of a person’s basic rights and freedoms
what are the 7 stages of a bill becoming a law
- legislation enters as a bill or resolution
- bill is sent to committees which schedule public hearings (nutritionists can present views here or in earlier planning stages)
- committee revises the bill and put in final form, if approved sent to rule committee for debate
- need approval from bith houses and the president
- differences between the two houses worked out in joint house-senate conference committee passing a reconciliation bill
- appropriations bill passed for funding
- regulations formulated that interpret and operate the law
a ___ regulation interprets a law and provides details and rules that put the policy into effect; carries the force of a law but is easier to change
___ are written by staff members of agencies charged with enforcing them
regulation are written by ___
staff members of agencies charged with enforcing them
who is the FTC and what to they regulate/enforce?
federal trade commission; regulate content of food ads; enforces truth-in-labeling; challenge product claims when product crosses state lines
who regulates content of food ads; enforces truth-in-labeling; challenges product claims when product crosses state lines
federal trade commission
who is the FDA and what so they do?
food and drug administration; ensures safety of some domestic and imported food products
who ensures safety of some domestic and imported food products
who is the FCC and what do they do?
federal communications commission; licenses radio and TV
who licenses radio and TV
what is the federal register?
notices of public hearings, proposed and final rules, agency decisions, published weeklys lists changes in USDA food programs
what give notices of public hearings, proposed and final rules, agency decisions, published weeklys lists changes in USDA food programs
what is the congressional record?
information from floor, NO HEARINGS, lists bill with sponsors and action, issued daily when congress is in session
what gives information from floor, NO HEARINGS, lists bill with sponsors and action, issued daily when congress is in session
what is the congressional index?
weekly update; identifies bill with sponsor and committee
what gives weekly update; identifies bill with sponsor and committee
what is advocacy?
aggressive form of action; plead cause of a group
- know facts and arguments for and against the issue
- be realistic-usually results in compromise
what is lobbying?
activities aimed at influencing public officials and legislators
what includes activities aimed at influencing public officials and legislators
that is Child Nutrition Reauthorization?
covers NSLP, SBP, CACFP, SFSP, SMP, WIC
the ___ covers national and international nutrition education, research, and funding
The Farm Bill
the ___ funds nutrition programs in the community and those that are homebound
The Older Americans Act
**Which of the counselor’s responses makes judgement about persons feelings, leads to offering of advice, not problem-solving, seldom helpful?
**Which of the counselor’s responses uncontrolled anger; may antagonize or humiliate client?
**Which of the counselor’s responses may make it difficult to solve the client’s problem or discuss it further. client is prevented from working through feelings?
**Which of the counselor’s responses attempt to clarify or gain more information?
**Which of the counselor’s responses is one of the best ways to respond, try to recreate the persons message in your own frame of reference. may lead to more client cooperation, helps client feel accepted and safe in expressing their feelings?