Building Competency in Diabetes Education THE ESSENTIALS

11-100 | CHAPTER 11

• To evaluate the absence or presence and extent of limitations in functioning. • To determine the effectiveness of treatments/therapies. • To assess the potential for optimal self-management. • To record baseline data and identify deviations from normal values. • To identify deviations from usual health or changes in baseline status. It is difficult and possibly dangerous to separate the functional from the psychosociocultural assessment for the purposes of discussion because it may imply that the functional assessment can be conducted without considering the therapeutic process involved. You are cautioned NOT to make this error. The patient-provider relationship is crucial to the success of any intervention; the primary purpose of the patient assessment, including the initial history and physical (functional) exam, is for you to establish a trusting, therapeutic relationship with the individual/family. Processes for assessment include the following: • Interviewing: Skill in working with groups and knowledge of group dynamics is necessary for conducting family interviews, but basic communication skills are essential for all situations. These skills include paraphrasing, reflective listening and problem-solving. (Therapeutic communication techniques are an essential part of health professionals’ education programs and will not be repeated here.) Terms specific to diabetes that should be avoided include compliance, cheating, good numbers and bad numbers, since they may affect a person’s self-esteem or self-image. It is also important to avoid referring to the patient as a ‘diabetic’ with the preferred term being a person who ‘has diabetes’. We need to recognize that assessment needs are ongoing. While a fairly comprehensive assessment is necessary to begin the health relationship, it is unlikely that all issues/aspects will be discussed or become known in one interview period. Individuals manage their health problems in the context of a cultural community and/or family unit, however family might be defined. Assisting the individual/family experiencing diabetes can be facilitated not only by gaining an accurate and comprehensive understanding of the current, pressing problem, but also by acquiring knowledge of who comprises the person’s family and what the family’s beliefs, values and health practices are. The best way to obtain this information is to conduct the assessment with the family present, but, at the same time, you should also be sensitive to the person’s wishes about whether or not to have family members at the interview. • Motivational interviewing: This describes an approach to interviewing that is designed for individuals for change by talking with them so that they feel listened to, heard and