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+ + Nutrition education or nutrition counseling

Based on the results of nutrition assessment, health care

providers can educate and counsel clients on the importance
of nutrition and ways to gain or lose weight, strengthen
immunity, manage symptoms of illness and medication side
effects, and address other identified needs.

Nutrition Counseling on Malnutrition and Nutrition education Nutrition counseling

Degenerative Diseases
Mira Mutiyani
8 June 2017

+ +
Nutrition education Nutrition counseling

n presents general information related n is a two-way interaction through which a

client and a trained counselor interpret the
to health and nutrition, often to results of nutrition assessment, identify
groups in clinic waiting rooms or individual nutrition needs and goals,
community settings. discuss ways to meet those goals, and
agree on next steps.
n Educators may be trained n Nutrition counseling aims to help clients
counselors or health volunteers who understand important information about
deliver prepared talks on specific their health and focuses on practical
topics, often using visual aids. actions to address nutrition needs, as well
as the benefits of behavior change.
n They should encourage clients to n Nutrition counselors should be dietitian or
ask questions and direct them to nutritionist or may be nurses or other
additional information as needed. facility- based providers or community
health workers or volunteers.


+ What makes counseling effective? + Ethical principles for counseling

n Optimal counseling contributes n The foundation of effective counseling n Provide accurate information. Clients should be able to trust that
to successful health and is asking questions about counselors words and actions are truthful and reliable.
nutrition outcomes. the clients symptoms and situation to n Keep client information confidential. Clients need to know that
be able to give appropriate information counselors will keep their information confidential except as
n Ideally, counseling should be and support the client to make healthy
choices at home. needed for their treatment or recovery.
done in a place where the
client feels comfortable and n Respect clients autonomy. Clients have the right to make their own
has privacy. n Counselors need to know not only what decisions without coercion.
messages are appropriate, but also how
to prioritize those messages depending n Keep clients interests in mind. Advise them based on professional
n Counselors should be trained
to understand and use support on clients needs and how to deliver assessment and offer alternatives if you cannot help them.
materials such as flipcharts, them effectively in a short time. n Do no harm. Avoid any interventions that could harm or exploit
counseling cards, take-home clients emotionally, financially, or medically.
brochures, data collection n This requires practice and experience.
forms, and referral forms n Be fair. Treat all clients fairly and without discrimination. Respect
effectively clients rights, dignity, and individual difference.

+ + GALIDRAA approach to counseling

Tips for Effective Counseling

Do more listening than talking. Listen to what clients think and respect their
feelings, even if information may need

Ask open-ended questions, not just Recognize and praise what clients are doing
questions clients can answer with
yes or no. Suggest actions that are possible for clients
given their situations.

Repeat what clients say to make sure Give only a little bit of information at a time.
you understood them correctly.
Show interest in and empathy for Use simple language.
clients problems and situations.
Avoid judging clients. Give suggestions, not commands.

NACS module, 2016


+ + What can nutrition counseling focus on?

What is a nutrition care plan?
After discussing the results of a
clients nutrition assessment and Malnutrition
agreeing on one or two achievable
goals to improve his or her nutritional
status (other goals can be added
later, after the first ones are reached) NCDs Pregnancy

counselors should help the client make

a nutrition care plan to achieve the Nutrition
goals, considering challenges the counseling
client might face. Infant and
Infection young

This can be kept in the clients file or

given to the client to take back to the HIV positive Sick
mother children
health facility on follow-up visits. Below
is a sample nutrition care plan.
NACS module, 2016

+ General tips for dietary counseling + Nutrition counseling on Malnutrition

n Make specific recommendations. For example, when

encouraging a caregiver to enrich a childs porridge,
explain exactly how often and how much to feed.

n Try to include portion sizes for specific nutrient-rich foods.

Use examples or pictures of local measuring utensils to
counsel on portion sizes.

n Use pictures of food groups, with healthy foods divided into

sections to show recommended daily consumption, to
counsel on dietary diversity Food groups are not
the same in all countries, but in general, they include
carbohydrates, protein, and micronutrients.

n Demonstrate how to prepare or use foods whenever



+ Updated UNICEF Conceptual Framework for the

+ Nutrition counseling on Malnutrition
Determinants of Under nutrition (adapted from UNICEF)

n The causes of malnutrition are n Severely malnourished

directly related to inadequate people need treatment with
dietary intake and disease ready-to- use therapeutic
but indirectly related to many food (RUTF),
other factors, including child
care and feeding, sanitation, n but moderately malnourished
and hygiene. people can improve their
nutritional status by eating
n Counseling should address adequate amounts of a
these various factors to result variety of locally available
in sustainable change. foods.

Nutrition in Deficiency/MM/2017 Regan L. Bailey, et al., 2015 6/9/17

+ Nutrition counseling on Malnutrition + Rwanda, Burundi - A story about nutrition


+ Counseling on how to increase energy intake + Counseling on how to address moderate

n Eat mashed bananas, baked bananas, n for a few minutes more to cook the egg. Do
sweet potatoes, nuts, or porridge not eat raw eggs.
enriched with oil and sugar. Add n Eat regular meals, even if you have been
honey to staple foods.
n Put nut paste, jam, butter/margarine, or prescribed fortified blended food, which
n Add milk, cheese, or oil to foods. tinned fish on bread. is meant to supplement the home diet.
n Fortify milk by adding 4 spoons (15 Eat nuts as a snack and put chopped nuts on
n Eat not only cheap staple foods to provide
ml) of milk powder to food or add nut paste to food.
500 ml of milk Stir well and keep in
a cool place. Use full-fat milk powder energy and protein, but also foods from
if available instead of skim milk n Eat foods rich in fat, such as avocado, fatty all food groups.
powder. Use this fortified milk in tea, fish, coconut, oil, and fried foods, if
on cereals, and in cooking.
n Eat foods with essential fatty acids (fish
n Add yogurt to soups, puddings,
cereals, and drinks. n Eat fermented and germinated (sprouted) and shellfish, oil, pumpkin seeds,
n Stir a beaten egg into porridge or
sunflower seeds, and leafy vegetables).
mashed potatoes and cook

+ Counseling on water, sanitation, and +

Counseling on food safety
hygiene (WASH)
n Wash hands with soap and flowing water before touching food.
n Wash hands under flowing water with soap or ash.
n Wash cooking utensils and store them in a clean place before using
n Wash hands at five critical times: them.
n Before preparing food
n Cook food until it is boiling or steaming throughout and all meat
n Before feeding another person (including breastfeeding) juices are clear.
or eating
n After using a toilet or latrine n Store food at room temperature for no more than 2 hours.
n After cleaning a babys bottom
n After cleaning up blood, vomit, urine, or feces n Reheat food until it is boiling or steaming throughout.

n Store food at sufficiently low or high temperatures to prevent bacteria

n Air-dry hands (shake off the water) instead of from multiplying
drying them on a cloth or clothing that may be
contaminated with germs.


+ Nutrition counseling for people with non- +

communicable diseases

n There is a rising global epidemic of non-communicable n Degenerative diseases

diseases (NCDs), including cardiovascular disease, stroke, n a type of a medical condition that causes a tissue or organ to
hypertension, cancer, and metabolic diseases such as diabetes deteriorate over time.
and obesity.
n There are quite a number of degenerative diseases and many of
them are associated with aging,
n or gets worse during the aging process.

+ Classified of degenerative diseases +


Cardiovascular Coronary
system diseases
Degenerative diseases

Myocardial Common types of degenerative diseases: cancer, diabetes, Parkinsons,

infarction Alzheimers, rheumatoid arthritis, and osteoporosis.

Neoplastic Medication
system Healthy life

Nervous system Healthy Good health/
Regularly medical check-
Alzeimers diet
exercise up


+ Patients perceptions of the nutrition care + Nutrition counseling for people with non-
communicable diseases

n it
is important that dietitians understand n Nutritioncounseling for people with NCDs should focus
patients perceptions of the nutrition on the following recommendations:
care they receive. n Eat less sugar and avoid sugary drinks.
n Avoid processed foods.
n Inthe context of nutrition, positive
n Eat plenty of fruits and vegetables to get needed vitamins and
perceptions of care are likely to be
important because of its association with
n Get regular exercise.
increased patient comfort, increased
behavior change and improved patient n Eat more fiber from fruits, vegetables, whole grains, pulses, and
n Eat fewer fatty and fried foods.

Ball L, et all, 2016

+ Client-Centered Counseling and Nutrition- Role Play, + Client-Centered Counseling and Nutrition- Role Play,
Demo: Diabetes Demo: Hypertension


+ +
SOP- Tahapan Konseling SOP- Tahapan Konseling

1. Setting penampilan ahli gizi sebagai konselor 9. Mengidentifikasi pengalaman konseling klien sebelumnya
2. Setting tempat konseling 10. Menjelaskan tujuan, proses, dan waktu konseling
3. Menyapa klien dengan menyebut nama dan senyum 11. Konselor mengatakan akan menjaga kerahasiaan klien
4. Mempersilakan masuk 12. Memohon ijin jika akan memegang/memindah posisi subyek
(saat pengukuran antropometri)
5. Berjabat tangan
13. Mengucapkan terimakasih (setelah melakukan pengukuran
6. Mempersilakan duduk antropometri)
7. Memperkenalkan diri kepada klien
14. Buat pertanyaan terbuka yang benar
8. Menanyakan kembali identitas klien: nama, usia, tempat tinggal,
pekerjaan, status keluarga 15. Buat pertanyaan tertutup yang benar

+ +
SOP- Tahapan Konseling Skenario
n NY. S, 45 tahun datang ke poli gizi atas rujukan dr. Penyakit Dalam disebuah RS pemerintah.
Diagnosa medis: diabetes mellitus tipe 2. BB= 64 kg,TB = 155 cm, LLA = 30 cm. Sebagai
16. Membuat catatan tertulis tentang hasil wawancara seorang guru NY X bekerja sekitar 7 8 jam. Ny. X rutin melakukan senam pagi di sekolah dan
sesekali melakukan jalan pagi. Jumlah jam tidur pasien sekitar 6 8 jam sehari. Pasien
mengeluh beberapa hari ini badan terasa lemah, pusing, sering kencing di malam hari. Nafsu
17. Memberikan respon verbal yang sesuai makan pasien baik. Kebiasaan makan: makan utama 3 kali sehari, dengan porsi 1 11/2 piring.
Suka makan makanan yang digoreng dan bersantan, jarang mengkonsumsi sayur dan buah-
18. Memberikan respon non verbal yang sesuai buahan. Camilan sering setiap hari, berupa gorengan, biscuit, keripik, dan minum teh manis
atau sirup 4-5 kali sehari.
19. Mengulangi (mengklarifikasi) penjelasan yang sudah Data lab:
diberikan n
n GDS : 200 mg/dl (N: 70-120 mg/dl)
n GD 2 JPP : 241 mg/dl (N: 80-140 mg/dl)
20. Merangkum hasil wawancara n HBA1C : 10.8 (N: <6.5)

21. Memberikan kesempatan kepada klien untuk n Data Fisik/Klinis

mengungkapkan apa yang belum jelas n Tensi : 120/80 mmHg

Obat-obatan yang diberikan: metformin, glibenclamid

22. Menutup wawancara dengan sopan n