ISSUE 16 | MAR 2022
Smart Bites
Five MI Pearls for your Counselling Skill Development
Supercharge your tauiwi tanga!
myWellaBee
Tara MacGregor
Amanda Buhaets
Emma Barraclough
Click where you see this link to learn more.
Smart Bites is the quarterly magazine of Dietitians New Zealand. We exist to build a strong and sustainable profession that empowers New Zealanders to make informed food and nutrition choices and inspire change that enhances the health and wellbeing of Aotearoa, New Zealand.
Discover us online: www.dietitians.org.nz
IG @dietitiansnz
Contact us: General Manager: Kath Eastwood admin@dietitians.org.nz Editorial team: Julie Carter, Anna Greenan, Audrey Tay, Lizz Whittred editorsmartbites@gmail.com
Contents
04 Editorial 05 Update from Dietitians NZ 10 Update from Council 13 Update from Te Kahui Manukura o Kai ora 15 Update from University of Auckland 17 Update from Head & Neck Cancer SIG 19 Update from Renal SIG 23 Five MI Pearls for your Counselling Skill Development 26 Supercharge your tauiwi tanga! 31 myWellaBee 34 We've been loving...
FROM THE EDITORIAL TEAM
Pause and Reflect Audrey
From Audrey: I'm writing this editorial on my phone while I sit outside Auckland City Hospital Emergency Department wearing scrubs and an N95 mask. I'm now a Covid-19 care navigator. I'm sure you can all agree that the start of 2022 has been a whirlwind. We've had to adjust and adapt, and adjust and adapt again. This issue explores the one constant in life change. I hope that you find something in this issue that challenges or inspires you as we move into a new season. From Anna: Relax and growth - my 'words for the year'. And as of this week, 'pause' has been added. Because when Covid hits, life pauses. And this week, Covid hit (us). Pausing can feel hard, and as you'll read in the pages ahead, pausing can be necessary; to acknowledge unearned privilege, engrained bias and so much more. And to reflect on the unlearning, new learning and action required. So, sit back, relax into some growth and then pause, to determine how best to move forward. SMART BITES | PAGE 4
Anna
Lizz
From Lizz: As Audrey wrote her editorial sitting outside Auckland City Hospital, I write mine as I'm sat at my desk staring at two screens. I'm in isolation, and not by choice. Part of me knew that I would eventually become struck down, especially with case numbers rising as they were and how transmissible Omicron is. I would regularly say, especially to my friends back home, it's only a matter of time. But another part of me is in disbelief. I thought that I would be able to dodge the bullet and get through this pandemic covid free. Alack and alas. While 2022 may have started off a little rocky, I'm hopeful for the year ahead. I'm also thankful for this magazine as it allows me to read and understand the experience of others, especially during times when I'm unable to physically connect with anyone. Happy reading.
FROM DIETITIANS NZ
The challenge of change Dietitians NZ is committed to being an honourable Te Tiriti o Waitangi partner and recently released a Statement of Intent. This is our way of signalling to Te Kahui Manukura o Kai ora how we intend to honour Te Tiriti o Waitangi and work in true partnership with them, celebrate our cultural difference and collectively improve health and wellbeing for all without prejudice. One of the ways we intend to achieve this is to be an ally to Te Kahui Manukura o Kai Ora. There are many aspects to being an ally: developing our cultural awareness, owning our privilege, and addressing our biases and prejudices. Everyone has a bias – conscious and unconscious, so we should all be prepared to receive feedback about our bias.Similarly, given many of us are part of the dominant culture in Aotearoa New Zealand, we know that as we work to become an honourable Te Tiriti partner, we will make mistakes. Owning them when they occur is also an important part of being an ally. This means resisting getting defensive, listening to feedback and while it is easy to take this feedback personally, striving to perceive it as a learning opportunity.
SMART BITES | PAGE 5
Kath Eastwood Dietitians NZ General Manager
So often, we hear about the importance of providing feedback and how we can deliver that in a safe and positive way. We would’ve all heard about ‘sandwiching’ constructive feedback – commend – recommend - commend. However, seldom do we hear about or spend time learning how to receive feedback. The impact of this perhaps is interesting when you consider the homogeneousness of our profession and the high expectations and perfectionistic traits many of us have, and the influence that may have on our ability to receive feedback. As we move to become an honourable Te Tiriti partner, Dietitians NZ, particularly the Council and General Manager, has received much feedback about our progress.
FROM DIETITIANS NZ
This feedback has reinforced some of our strengths, kept our behaviour on course, clarified the effects of our behaviour, and increased our ability to detect and correct errors on, both individually and as a collective. Receiving feedback though, at times, has been challenging. We share some of our key learnings below and we encourage you to reflect on these as they relate to your own contexts. Listen with the intent to understand, not the intent to reply This might sound easy but so often we catch ourselves wanting to defend our position before a person has finished speaking. When you really listen to what is being said, rather than making assumptions about what might be said, you will absorb more information and be less likely to focus on your response and/ or get defensive. Be open, even when it makes you feel uncomfortable Being open is about being receptive to new ideas and different opinions. Often, there is more than one way of doing something and others may have a completely different viewpoint on a given topic. It doesn’t make one right or wrong, they are just different. Being open is also about creating an environment that is safe so others feel comfortable and can be open about themselves, ideas, and perspectives. SMART BITES | PAGE 6
Understand the message before responding For us, this is about being curious, asking questions and repeating key points so we know we have interpreted the feedback correctly. This can be quite challenging especially when you want to respond but so critical, as often we don’t interpret things as they were intended! Take time to reflect on the feedback We take time to reflect on feedback – both individually and collectively and consider the consequences of using or ignoring the feedback. In the end, our response is our choice. There have been times when we have disagreed with some feedback and that is ok too. In those instances, it was important to test that feedback by reaching out to other trusted colleagues and advisors. Reflecting has allowed us to process our experiences with purpose with the goal of gaining insight and learning. It has enabled us to clarify our thinking, notice how it has made us feel, record some learnings and ask questions. Importantly it has helped us approach our Te Tiriti journey with a growth mindset. In some instances, we have used the feedback we receive to implement some suggestions and change and in others, it has been to spend more time discussing the feedback or particular issue we are trying to resolve.
FROM DIETITIANS NZ
We also received a lot of feedback through the engagement survey that was circulated last year. You can read more that here and the changes we are making as a result of this. Just like our journey to become an honourable Te Tiriti partner we have worked hard to understand the feedback provided in the survey, be open to new ideas and opinions (they were plenty!), be curious and reflect on the themes provided in the survey.
We don’t underestimate the challenge of positively receiving feedback. However, have you ever noticed you can’t spell ‘challenge’, without the word ‘change’? The challenge of receiving (or providing feedback) is not supposed to overwhelm us, rather it is an opportunity for us all to continue to learn & grow. The only real obstacle in our path to possibility is ourselves.
2022/23 Memberships OPEN! Dietitians NZ memberships for the 2022/23 year are now open! All Dietitians NZ membership categories include a range of member benefits, designed to assist you in your work. Valued at over $3200, memberships are available from just $96.30!! More information about the member benefits can be found here. To see which membership category best applies to you, click here. To renew your membership, simply log-on to the members' section of the website and select 'Renew Membership' from the menu on the left-hand side. If you're new to Dietitians NZ and joining for the first time or after some time away, you can renew your membership here. The 10% early payment discount or payment via quarterly instalments only applies until 25th April so renew today! SMART BITES | PAGE 7
2021 Engagement Survey The 2021 engagement survey was circulated to all NZ Registered Dietitians and Dietitians NZ members. It was completed by 267 people (approx. 30% of the profession). The information you provided has really helped us reflect on our mahi over the last year and plan for 2022.
Results Capturing the breadth and describing the role of a dietitian is challenging
The biggest challenges working as a dietitian The value (or lack thereof) of our profession and the importance of nutrition Managing and prioritising professional development/ keeping up to date Lack of staffing and/ or increasing workloads, including administration Staying connected and nurturing professional networks
Most highly valued member benefits
What we could do more of
What we are not doing but should be
Education in Nutrition Advocacy Branch membership SIG membership
Greater advocacy A more accessible and user-friendly website More professional development opportunities that are better co-ordinated, more accessible with virtual options and cover a broader range of topics
More advocacy Media statements and/ or increasing public profile Nationwide collaborative resources register and platform for sharing resources, including National Standards of Care
3 biggest challenges for the profession over the next 3 years The health & disability system reform The value of nutrition & dietetics Inadequate resources and funding
SMART BITES | PAGE 8
Members want more support to assist them with their cultural development
What to expect in 2022 A new strategic plan with key strategic initiatives Te Tiriti o Waitangi Hub on the website that will be home to lots of cultural development opportunities and resources to support you in your journey More professional development opportunities that are better coordinated, more accessible with virtual options and cover a broader range of topics Coffee catchups for students and new-graduate dietitians Public-facing campaigns with collaborative partners A new digital platform that is aligned with our direction of travel and key strategic initiatives The development of our elevator pitch! – a succinct & persuasive description of what we do and why we do it! Informal drop-in lunch time chats with Kath – this is an opportunity to hear about the advocacy work we are doing and to share any feedback you might have. We hope this will help improve communication and transparency between National office & members Greater support of Branches, SIGs and all Dietitians NZ volunteers SMART BITES | PAGE 9
FROM DIETITIANS BOARD
Surges, Reform and BAU – holding onto the board while riding the wave Surges Aotearoa New Zealand is surging – with Omicron peaks, mobilisation of the health workforce and zoom driven internet traffic. Once again Dietitians around the motu acknowledge the impact of COVID19 on the lives of our Auckland colleagues who are leading the health system response to ‘peak’ Omicron.
Prescribing Standards In the spirit of collaboration, work on inter disciplinary prescribing standards (Smart Bites Nov 2021) has reached a critical stage with establishment of a Tangata Whenua, Tangata Tiriti advisory group. At this stage the goal is development of a high level statement rather than common prescribing competency standards.
Last week the MoH requested health professionals consider flexing into COVID19 related roles via the surge workforce. Many Dietitians will have received this request by text.
BAU Business as Usual provides some certainty in a rather uncertain world. For Dietitians and the Secretariat 31 March 2022 remains the last day for renewing Annual Practising Certificates (APC). For Dietitian Prescribers 31 March 2022 is the final day for completing the annual Prescribing Quiz.
Reform In a recent MoH update on regulatory reform, Health Workforce outlined their principle-based review of the regulatory framework governing roles and responsibilities of health professionals. Four principles determine the review framework: Te Tiriti obligations Collaboration Workforce supply Alignment with the Health Charter and governance arrangements of Health New Zealand and the Māori Health Authority. These principles reflect key issues for all health services in 21st century Aotearoa!
SMART BITES | PAGE 10
A big shout out to Sherin de Souza, Operations Manager, Registration Officer in her first-year processing APCs. Dietitians are appreciating her prompt responses to queries and efficient resolution of issues, including credit card glitches. Life is busy, additional demands on our time can erode healthy routines. Only healthy health professionals can care for others. Prioritising BAU health promoting behaviours is the best investment we make each day. Ngā manaakitanga Penny Field Acting Registrar Dietitians Board
FROM COUNCIL
Kia ora koutou I hope you are all keeping safe and well as we hit this next phase of the pandemic. The implications to us all in the coming days, weeks and months as this current wave impacts our homes, our whānau and our workplaces more intensely than before are significant. We need to be realistic of our expectations for ourselves and of those around us, take time to reflect on what we have done as well as take time to look at how we move forward. We need to remind ourselves that we achieve more working together than working alone. What is Council doing together to support Dietitians NZ? As you are aware, we released the Dietitians NZ Statement of Intent late last year. I encourage you to keep referencing this Statement and the rationale that sits behind it in the work that you do. Council is now working with Kath on what operationalising our Statement of Intent looks like beyond Council – to our membership, to our Branches and our SIGs. We will continue to work with all of you on this but stress that this is something that we don’t have all the answers to. We encourage you to look at it, determine where you are in your journey and look at ways to apply and demonstrate the Statement of Intent in your practice.
SMART BITES | PAGE 11
Julia Sekula DNZ Council Chair
Our work towards a Te Tiriti Model of Governance continues and Council are working on the revision of our constitution (Rules), as we progress forwards. We will be consulting with members, Branches and SIGS on key areas where change is needed to move us to this model in the coming months. We value your feedback and will use as many methods as able to engage with you all. Council continues to work on developing the values for our association and as we make progress on these, we will request feedback on what these mean to members, Branches, and SIGS and how they underpin what we do, combined with our Statement of Intent.
FROM COUNCIL
Most recently, Council has been busy behind the scenes reviewing the Awards criteria to better reflect our commitment to Te Tiriti o Waitangi and there have been a few changes. These awards acknowledge excellence, encourage lifelong learning and provide an opportunity for members to gain financial support to attend conferences, seminars, workshops and undertake post-graduate study, either in New Zealand or overseas. Please do take time to see if someone you know would be a worthy recipient of one of these awards or consider if you might apply yourself. In the coming months, Council will continue work in all of the areas mentioned above. Good things take time and we don’t as yet have all the answers.
SMART BITES | PAGE 12
We are continually learning as we navigate the changes required in our move to a Te Tiriti Model of Governance. We understand that everyone will be at different stages as to what this change means in a practical sense. What we hope is that as we keep learning, we understand and reflect when we make mistakes, when we do things well and when we learn new things and we do this collectively. Noho ora mai, Julia
FROM TKMKO
TE KAHUI MANUKURA O KAI ORA Tēnā koutou katoa Kia whakatōmuri te haere whakamua I walk backwards into the future with my eyes fixed on the past. We are already well on our way through the first quarter of 2022, and it’s shaping up to be another interesting year. However, before we look to the future, I want to acknowledge the past and our tupuna. Waitangi Day and thus the signing of Te Tiriti o Waitangi (6th February 1840) brings a time of reflection for us as Māori. We reflect upon the grievances caused and continue to be instigated, to Māori by the Crown. The loss of our whenua, our Matauranga Māori, our pūrākau, and more pertinently our hauora and mana. As Māori dietitians, we work hard to reclaim the matauranga and tikanga our tupuna left for us which has been lost. We awhi our whānau to navigate the health system and reclaim their mana, and we awhi each other to be better for our whānau and for ourselves. However, we are unable to do this alone.
SMART BITES | PAGE 13
We need our Tangata Tiriti colleagues to tautoko this kaupapa by upskilling themselves in New Zealand History and becoming aware of what has been lost to Māori, to understand that Māori dietitians are a scarce resource and they can’t be the “tick-box” exercise for programmes or services, and to demonstrate that as a practitioner you are an ally to Māori by calling out the racism and discrimination you witness in your environment. Looking now to the future, Te Kahui Manukura o Kai Ora is beginning their journey of capacity and capability building. As a rōpū, we are currently in the process of undergoing an entity change and becoming an Incorporated Society, meaning we will have standing as our own rōpū. This is going to see a new way of being for Māori Dietitians, and we are looking forward to our first AGM on 11th March 2022 at Te Manukanuka o Hoturoa Marae. Some of the goals that we are working towards are seeing more Māori Dietitians in our rōpū, being able to work in culturally safe workplaces, and being able to utilise the teachings of our tupuna to support our practice and the care of our whānau.
FROM TKMKO
All of this mahi couldn’t have been done without the amazing awhi and tautoko of Daena Moller (Kaimahi for Te Kahui Manukura o Kai Ora) and Iris Pahau (Tikanga Advisor). If you are a Māori dietitian, or know of any who would like to become a part of Te Kahui Manukura o Kai Ora, you’re more than welcome to contact myself or Daena. We would love to have you on board! Ngā manaakitanga
SMART BITES | PAGE 14
Brittani Beavis Chair Te Kahui Manukura o Kai Ora
FROM UNIVERSITY OF AUCKLAND
FLIPPING THE CLINICAL NUTRITION CLASSROOM FOR REMOTE LEARNING With the shift between remote and inperson teaching every year due to COVID-19, Auckland Nutrition and Dietetics has incorporated different elements into classes to offer asynchronous and synchronous components.
It helps students learn to better selfregulate work and develop social connections to other students in the class.
Flipping our classes has been one effective way to achieve this. Flipping the classroom is a pedagogical approach where students first explore new course content outside of class by viewing a pre-recorded lecture video or digital module or completing a reading or preparatory assignment. In-class time is organised around student engagement, inquiry, and assessment, allowing students to grapple with, apply, and elaborate on course concepts. Inclass sessions typically entail collaborative coursework and case studies, problem sets, or structured discussion. Research suggests that flipped classroom helps students self-pace work, learn on their schedule, access resources during key times, and learn from others. Dr Rajshri Roy SMART BITES | PAGE 15
FROM UNIVERSITY OF AUCKLAND
The Flipped Classroom model in the University of Auckland Dietetic Programme focuses out-of-class time and effort on lower-level learning with acquisition of basic knowledge about clinical nutrition and dietary management of different disease states. In-class time is focused on higher-level learning such as applying, analyzing, evaluating, creating. Out of class time, students are learning knowledge on their own. Students may: Read supporting materials such as lecture notes, systematic literature reviews, position papers, guidelines, evidence statements, etc. Watch videos, recorded lectures or webinars Take notes, complete worksheets, write a summary Take a quiz to assess remembering and understanding of different medical nutrition therapy concepts In class, students: Work on nutrition case studies, applying concepts they learnt during their out of class time Evaluate various nutrition interventions Write PES statements Analyse or compare strategies or approaches with peers Create summaries, written materials, presentations, infographics, etc. SMART BITES | PAGE 16
Lecturers and guest lecturers at the University of Auckland Dietetic Programme have worked on adapting this flipped classroom approach to improve student engagement with remote teaching and learning. Our approach incorporates less didactic lecturing, enhances the diversity of viewpoints in a classroom, adds variety in activities, and allows for early identification of at-risk students before they go on to workplace placements. The students who provided feedback about flipped classroom lectures over the last two years reported that it deepens their impression of relevant knowledge, and from the performance of their peers can provide more personal thinking. The students reported that active learning allows them to become the protagonists of teaching activities. Students enjoy preparing in advance and participate in discussions actively.
FROM HNC SIG
AN UPDATE Head and Neck cancer (HNC) is now the fifth most common cancer worldwide. There are up to 40 different types and sub-types of HNC. High alcohol consumption and smoking rates have traditionally been the risk factors for HNC; however, in the past several years, human papilloma virus has been the leading cause of HNC, particularly oropharyngeal carcinoma. Therefore, we are seeing younger patients with young families who are highly functioning.
The head and neck region is complex, comprising many structures vital to physical functions such as swallowing, chewing, speech and breathing, and physical appearance and self-image. It is not surprising that between 30-50% of patients are malnourished at the time of diagnosis.
SMART BITES | PAGE 17
The cause of malnutrition is multifactorial, including the primary location of the tumour, previous poor nutritional habits/choices, and treatment-related side effects. Treatment for HNC can include surgery, radiotherapy, chemotherapy, or a combination of all three. The side effects are physical and psychological and impact both the patient and their loved ones. Nutrition has been recognised as the second most important factor in predicting long term prognosis in HNC. Useful websites: Head and Neck Cancer Cancer Council Australia After many years of talking to other Dietitians working in the HNC space and always commenting that it would be great to share knowledge and experiences, we finally formalised the HNC SIG group partway through 2021; this is a subgroup of the Oncology SIG. HNC patients have a long journey; therefore they are seen by different Dietitians working in different sectors such as the acute hospital setting, radiotherapy and chemotherapy units and then in the community. There are both public and private units throughout NZ treating HNC, so it has been fantastic to have a range of Dietitians joining the HNC SIG from all these areas.
FROM HNC SIG
We meet via Zoom every month, and the plan is that a different centre around NZ will present something of interest such as a case presentation, review a journal article or guidelines and use the time to discuss all things HNC related! It is only early days, but everyone involved has been really positive, enthusiastic, and engaged so far.
Belinda Reeves
Join the HNC SIG! The Oncology SIG has been a longstanding group, and is a fantastic platform to connect with other Dietitians working in oncology throughout New Zealand. If you would like to join the SIG, please contact Belinda at belinda.reeves@mercyascot.co.nz The HNC SIG also needs a Convenor! If you are interested in taking this on, please contact Kath Eastwood.
SMART BITES | PAGE 18
FROM THE RENAL SIG
An Update
World Kidney Day was on 10th March 2022 and the Dietitians NZ Renal SIG is calling on all dietitians to be aware that 2022 is the year of “Kidney Health for All”. The International Society of Nephrology (ISN) is reminding us all to focus on increasing education and awareness about kidney health. Kidney disease is projected to be the 5th leading cause of death by 2040. All dietitians can share the following: Encourage general public to adopt healthy diet and lifestyles (access to clean water, exercise, healthy diet, tobacco control, and climate change prevention) to maintain good kidney health, preserve kidney function longer in those with CKD, and increase overall awareness of the importance of kidneys.
What are some of the highlights for 2022 so far, from the Dietitians NZ Renal SIG? 1. Continue to share regular newsletters and collaborated on projects together. We have been successful in developing new nutrition information sheets on dietary phosphorus, potassium and kidney stones. We have become agile in connecting amongst smaller groups via zoom and Microsoft teams, allowing the release of many new resources that better suit the needs of our renal patients. 2. Sharing the KDOQI 2020 Clinical Practice Guideline for Nutrition in CKD: 2020 Update. This is useful for non-renal dietitians and everyone is encouraged to read here. 3. Lyn Lloyd, Fuchsia Goldsmith and Jennifer Robb attended the Australia and New Zealand Society of Nephrology (ANZSN) Auckland Chapter meeting at the Sofitel, Auckland, March 2022.
FROM THE RENAL SIG
"It was a great privilege to be able to attend the ANZSN conference in person after nearly two years of meetings via Zoom. It was a good example of a hybrid conference in action with attendees and presenters in Auckland face to face, and Australia and New Zealand via Zoom. Covid has degraded the connection between teams and collaboration due to the lack of face-to-face meetings, so it truly was a celebration of what we are managing to do even in the Omicron surge."
Fuchsia Goldsmith, Renal Dietitian, North Shore Hospital, Waitemata DHB, spoke on Plant-based diets In keeping with the meeting’s theme of “Green Nephrology”, Fuchsia spoke about plant based diets. The Eat-Lancet Report on sustainable diets advocates for a plant based diet and Harvard Medical School estimates that 1 in 3 early deaths could be prevented by following a plant based diet. Patients with kidney disease can also benefit from plant based diets due to improved management of comorbidities (e.g. diabetes & heart disease), while simultaneously improving fibre intake, alkalising potential and gut health. Due to the higher satiety factor, plant based diets may not be appropriate for patients with malnutrition. SMART BITES | PAGE 20
Jennifer Robb, Renal Dietitian, Auckland City Hospital, Auckland DHB spoke on Nutrition Care for Chronic Kidney Disease (CKD) Jennifer highlighted to nephrologists and registrars that, by appropriate nutrition screening and referrals, extensive assessment and use of Nutrition Care Process (NCP), renal dietitians can diagnose malnutrition to ultimately decrease mortality and hospitalisation of people with CKD. Lyn Lloyd from Auckland City Hospital, Auckland DHB, spoke on Kidney Stone Prevention Lyn discussed the prevention of kidney stones focussing on the medical and nutrition management and evaluation of risk of stone formers with calcium oxalate stones. She highlighted the key role renal dietitians have in prevention of stones given that nutrition is the primary intervention to prevent stone recurrence. She emphasised the importance that registrars and nephrologists have in supporting these patients as kidney stones are preventable. Lyn is on the CARI Guidelines Group who are updating the guidelines for management of kidney stones to be completed in 2023.
FROM THE RENAL SIG
Professor Rob Walker presented on the demographics of CKD. The key findings were: It is estimated that there are 54 000 people in Auckland with CKD People with CKD markers are attending primary healthcare, however there is a gap in being provided with appropriate treatment and compliance with treatment. This is thought to be driven by CKD being a largely asymptomatic disease. Due to the magnitude of difference between CKD rates in Pacific / Maori people compared to non-Pacific/Maori, it was suggested that testing for CKD should be done 10 years earlier for Pacific / Maori people.
SMART BITES | PAGE 21
In Summary: As we move towards Health New Zealand as a SIG, we are very aware of the importance of being proactive and reaching out to groups influential in the health care setting. We realise the relationships and networking is very important. Jennifer Robb, Lyn Lloyd and Fuchsia Goldsmith
SMART BITES MAGAZINE
We Need You! We are looking for star writers and designers to join our magazine editorial team Writers: - Contact potential contributors leading up to each issue - Edit submitted articles - Produce original articles on relevant nutrition/health-related topics -Able to dedicate at least 10 hours per issue Designers: - Produce original magazine cover designs and photos - Organise magazine layout using Canva - Able to dedicate at least 6 hours per issue INTERESTED OR NEED MORE INFO? SEND AN EMAIL TO: EDITORSMARTBITES@GMAIL.COM
Five MI Pearls for your Counselling Skill Development Helping people to change behaviours is the ‘bread and butter’ of most Dietitians’ daily practice. Interestingly, it is often the most challenging aspect of being a Dietitian and the part of our work for which we receive the least preparation. Written by Tara MacGregor PACFA Reg Clinical & APD
Most health professionals are drawn to Motivational Interviewing to assist with the challenge of supporting people who struggle with change because it is practical, learnable and has a solid evidence base behind it. If you’ve ever been curious about MI, you may enjoy considering 5 of the most useful ‘pearls’ that MI has to offer to transform your behaviour change practice.
1. Think Presence NOT Persuasion Ever been in a session with a client that felt like a wrestling match? Taking up the argument for change and trying to persuade our clients to change typically only ends up entrenching the very behaviours we are trying to help with! Persuasion comes in all sorts of cute disguises: warning of negative outcomes, education with facts, cheerleading and enthusiastic advising. SMART BITES | PAGE 23
Tara MacGregor
Under pressure, we all do it. The evidence says: best not. MI guides us to drop the argument and our need to make something happen, and to instead focus on being present by really listening to our clients – the way toward change will sit within them.
Learning how to reflect well with our clients is the key to this shift and MI encourages us to try and reflect once before asking a question. Sound simple? It can be challenging but well worth it.
2. Move from Checklist to Conversation Often as practitioners, we can get caught up in our assessment of the client’s ‘problem’, saturating the session with things we plan to fix. We become the 'deficit detective' and place ourselves firmly in the driver's seat of the change process.
Practice Pavestones Newsletter is a FREE resource for Health and Counselling Professionals. The newsletter is produced to support practitioners to develop sound client centered counselling skills to facilitate effective client engagement and behaviour change. Subscribe here!
In MI, our focus is on inviting real, strengths focused conversation with the client to enhance their motivation. Stop and think – do you really need all that data to assist someone find their own way forward? How does ticking the checklist of data collection help the client to understand themselves better? Ultimately, that's what drives change forward. SMART BITES | PAGE 24
'The individual is a garden to be tended, not a machine to be repaired. Motivational Interviewing doesn’t analyse the broken machine. It tends and cultivates the garden.' - Stephen Andrew
3. Stop Telling & Start Asking Rather than concentrating on what we need our client to know about change, MI invites us to shift our lens to learning about what the client needs us to know. In MI, our questions are purposed with ‘looking for the good’ to draw out of our client their best ideas about a better life. To do this, we press pause on telling the client what to do and ask what they think they want to do. We press pause on telling our client why they should change and ask them what their best reason for change are. And it's not that MI is against giving advice. We are just wise to first establish the client’s own need to receive it.
4. Put down the Pom-Poms!
5. You Guide They Decide
MI invites us to rethink praising our clients and this is a big learning for many students of MI. Whoever thought our enthusiastic congratulations of our clients could be an issue?
This pearl reminds us of the inherent division of responsibility in conversations using Motivational Interviewing. Practitioners new to MI can often have reservations that MI is all about ‘leaving everything up to the client’. Whilst there are elements of truth in this, it can be a dangerous oversimplification if it invites passivity from the practitioner. In MI it IS the practitioner’s job to skilfully facilitate and guide a conversation towards change if we have a willing partner in our client. It is a conversation which requires the practitioner to deliver focused direction through a compassionate heart, keen listening, and skilful questioning. It is then our client’s job to decide if, when and how they would like to follow through with change.
MI invites us to channel the energy of this well-meaning communication into affirming our client as an alternative. Affirming involves looking for the strength and resource implicit in a client’s behaviour or character and handing it back to them. It is theirs after all! Here’s an example. Instead of: ‘I’m so proud of you! that’s amazing, Well done!’ MI suggests: ‘You're someone who doesn't give up. You nailed it!’ When guiding a conversation using MI we want our clients to be leaving with less of us and more of themselves to enhance real motivation for change.
About Tara Tara MacGregor is a dual qualified Counsellor & Psychotherapist and Accredited Practising Dietitian in private practice in Australia with over 25 years’ experience in health. Tara is a PACFA Accredited Supervisor and Member of the Motivational Interviewing Network of Trainers (MINT). She is the owner and operator of Practice Pavestones, a business striving to provide innovative and quality experiential training to health professionals. You can read more articles about MI by Tara in her newsletter archives here. Click here to access Tara's website.
SMART BITES | PAGE 25
Supercharge your tauiwi tanga! I am striving to become an honourable Tangata Tiriti (treaty partner), and I want to bring as many tauiwi (non-Māori) as I can on this journey with me.
I know dietitians love a good tick box, but there’s no blueprint we can follow for this. We have to work together to make our own path forward. To get your head in the right space, I recommend reading Tina Ngata’s article, ‘What justice is required of tangata tiriti’ as a good place to start. Working in primary care and public health for the last two years has really opened my eyes to the daily injustices Māori still face, and how much racism we are blind to. I mean, even plasters are racist; they come in skin colour… my skin colour. If you think I’m being a bit extreme, check your pākehā privilege to reflect on your own situation. Or watch ‘The tauiwi tautoko approach to communicating across difference’, a fascinating video about how our social advantages can make it harder to see structural injustices – and the power of listening to help uncover them.
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Amanda Buhaets
A recent webinar; ‘Supercharge your tauiwi tanga!’ came at just the right time for me, as I began to acknowledge my feelings of whakamā /shame and kaniawhea / guilt at my ancestors’ actions and their contribution to our sick system. I’m now focusing on what action I need to take, and how we as pākehā working in health, can honour this mahi in the now.
Before going on this journey, I’ve had to admit some truths to myself. I am currently sitting in normalised dominance and reap the material benefits of colonial privilege. If I want to try and respond to these injustices, I must be willing to make sacrifices, shift my world view and get out of my comfort zone. The Radio NZ series ‘Land of the long white cloud’ is an inspiring watch, interviewing seven different pākehā about how they overcome feelings of guilt to take action against racism. Looking back to the 2020 election, I was ready to cast my votes for Māori party – but when I spoke to my friends and whānau, they talked me out of it, calling it a ‘wasted vote’. I wish I had been introduced to the tauiwi tautoko approach then, and used values-based messaging to deal with racist ideas. I need to have confidence in my decisions first, and then I will be able to respond to others more confidently.
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When asked how those of us with class and wealth privilege can contribute to decolonisation on a daily basis, one of the facilitators suggested that we could either donate our money and/or our time, like attending protests or land occupations. They had some suggestions for donations, for example e-tangata, an independent Māori & Pacific media platform or STIR which focuses on ending institutional racism in the healthcare sector. I have also come across Papawhakaritorito Charitable Trust, which undertakes kaupapa Māori research, education and development in relation to Māori food sovereignty. There’s also Para Kore, a Māori, not-for-profit organisation with a kaupapa based on whakapapa to Papatūānuku, or others here. I’ve decided to start local and have reached out to a community group near me.
If you - like I was (and be honest with yourself) - only completed a Te Tiriti o Waitangi activity each year for CCP points, but have decided it is time to make it more meaningful, I awhi/embrace you. Some valuable starting places might include: ● Read Kia Mau -Resisting colonial fictions by Tina Ngata; a collection of essays that gives a really powerful historical context, and is free to download with a suggested koha. ● I haven’t got to it yet but Moana Jackson’s ‘Imagining Decolonisation’ has been highly recommended to me. In fact, anything from this world famous in Aotearoa Māori lawyer will be worth a watch or read. ● Listen to some podcasts. I recommend Rediscovering Aotearoa by Re:news, where you will hear from fascinating young Kiwis as they discuss the impacts of colonisation, modern race relations and how they are decolonising themselves. ● If your kids are in school, they will learn a lot more about NZ history than we ever did. Make sure you are up to speed by listening to The Aotearoa History Show. ● Watch some enriching videos like why anti-racism and black lives matter in Aotearoa or Moana Jackson’s Once we were gardeners 10 minute video on re-affirmations of old and bitter prejudice. ● Join a few facebook pages like Te tiriti based futures and anti-racism or TmMMA: pākehātanga / whiteness circle or Tauiwi mō Matike Mai Aotearoa | Non-Māori for ending colonisation. Get amongst discussions, ask questions, be open – I’ll see you there!
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Something I’m doing this year and for our future work with primary care, is consulting with Māori health to codesign the content and presentation of our training sessions. Our traditional approach of consulting with subject matter experts might be quicker… but how meaningful is it for the people we most want to empower? What works for Māori, works for all, so why don’t we get it right from the start. It will be worth the wait.
I’d love to share our learning, reflections, ideas, mahi and resources as we move forward. I’m interested to hear if you have implemented something in your workplace that’s been successful? I also look forward to discussing it with Te Kahui Manukura o Kai Ora (Māori Dietitians Rōpū), to find out how this mahi can be meaningful and that we stay culturally competent and appropriate. Amanda Buhaets, NZRD
If you’re like me and you're discovering what’s out there, what groups to join, what action to take, let’s do it together.
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ABuhaets@adhb.govt.nz
The DNZ Conference is being held as a hybrid event this year. In-Person Event (Christchurch): Wed 31st Aug – Thur 1st Sep Online event: Wed 31st Aug – Fri 2nd Sep
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myWellaBee How being a dietitian got me to where I am now
If you told me at school that I would be part of a start-up aiming to make the complex world of food simpler and easier to navigate for families around the world, I don’t think I would have believed you. But when I piece together my dietetic journey, it all makes sense. Growing up with a brother with type 1 diabetes, food in our household was complex. My favourite subjects at school were biology and food tech which led me to study a BSc (Human Nutrition) at the University of Otago. I loved it so much I continued to complete a Master of Dietetics with Distinction.
Emma Barraclough
I don’t think I was prepared for life after graduation and finding that first job. I had my eyes set on becoming a Diabetes Dietitian, but the universe didn’t have the same idea. I got an opportunity to put my foodservice skills into practice as a Café Manager and then moved on to become Assistant Foodservice Manager at Middlemore Hospital for Compass Group. I thrived on the fast-paced Foodservice environment. Whilst at Middlemore, I was managing the hospitals nutritionals, which encouraged me to explore Food Industry.
I made the leap to Danone Nutricia and utilised my transferable skills as a Dietitian in a variety of roles including managing all product complaints across Australia and New Zealand, liaising with Danone’s global factories and working in the Quality department of the dry-blending factory making infant formula. Currently I am a dietitian for the tailored nutrition, kids and plant-based portfolios. In April, I am beginning an exciting new stage of my career as the Food Services Manager for Counties Manukau Health.
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When I was approached by myWellaBee to be an Expert Registered Dietitian Advisor, I saw the opportunity to bring my foodservice, industry and clinical experience together to help make life easier for people with allergies and intolerances. The team at myWellaBee, a Kiwi-based global food-tech start-up, are on a mission to make the complex world of food simpler and easier to navigate for families everywhere. myWellaBee is a food search engine that you can personalise to address your specific dietary needs. Just filter for the combination of allergies or intolerances that affect your household’s diet, and myWellaBee finds the foods you can rely on and helps you track them down. Our founders, Aziz and Craig, both have young children who suffer from food allergies and intolerances.
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Like me, they know from personal experience that it’s a real struggle to discover and find food that can cater to our families’ unique dietary, lifestyle, and budget needs.
The team at myWellaBee, a Kiwibased global foodtech start-up, are on a mission to make the complex world of food simpler and easier to navigate for families everywhere.
At myWellaBee, we want the half a billion people who avoid allergens when shopping for food and beverages to experience freedom of choice when it comes to feeding the family. We are aiming to launch our Beta product across New Zealand in April 2022 – with plans to roll it out to more countries in the months and years ahead. Watch this space!
We understand the important role dietitians have in helping people with allergies and intolerances so, as we prepare for launch, we encourage you to try myWellaBee for yourself. As a registered user, we’ll be in touch to ask for your valuable feedback, which will help us to create a platform that complements your Dietitian tool-box and best serves you and your patients.
You can sign up for early access at www.mywellabee.com.
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