Facilitating Change and Optimizing Health and Well...

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


Three Coaching Skills

Perceptive Reflections

Open-Ended Inquiry

Mindful Listening


Mindful Listening

Mindful Listening

Show Interest

Observe non-verbal

ques

Avoid Interruptions

Avoid prejudice

Open-ended

Inquiry

Reflect

Summarize

Open-Ended Inquiry

Open Ended Closed Ended

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?


• 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



• 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


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


Barriers

• Distractions

• Fixing

• Stereotypes

• Agenda

• Lack of time

• Environmental

• Ambivalence

• Cognitive

• Access

• Lack of time

Putting it Together

Evocation

Compassion

Acceptance

Partnership

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-

Questions

[email protected]

mailto:[email protected]

mailto:[email protected]

Facilitating Change and Optimizing Health and Well...

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