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Diabetes case study - Alison's story

Case Study

posted by susan fullerton smith on 16 December 2013

Flexibility is my middle name….’ says Alison.

Quick Overview:

Susan: I’m working with the long term conditions team at the Ministry of Health who have a particular focus on cardiovascular disease and diabetes, in supporting the sector with their health targets. My role involves capturing stories around patients, PHOS, DHBS practices etc. for publication internally and on resource sites such as HIIRC.

I’m interested to hear about your role and how you work with healthcare practitioners and within the community….

Alison is a Porirua Community Dietitian, a role created in 2009 and funded out of a Long Term Care programme within the Kapiti and Coast DHB. Alison works with people at risk from cardiovascular disease or poorly controlled type 2 diabetes. ‘My passion is to help change food choices for better living,’ says Alison. ‘My role is unique in the fact that I’m spread across all 3 Porirua PHOs which removes many access and referral barriers immediately.’

Susan: Tell me about the community you work within?

Alison: The high-risk community I work with include Māori, Pasifika and refugee populations as a majority.’

Susan: What would a typical day look like?

Alison divides her time between multi-disciplinary clinical visits, home visits and community education work. She finds the clinical visits a great mentoring and up skilling opportunity for health practitioners, who can then pass on her key nutritional methodology in discussions with many Long Term Condition patients.

A typical day for Alison might see her working alongside a clinical nurse for a morning seeing Diabetes and CVD risk patients. Afternoon will bring some follow up paperwork followed by an evening diabetes education session out in the community. Alison works with support agencies such as Pacific navigator networks, community health workers, church groups and translators to ensure the best access to those who need it most.

Susan: Tell me about your work and give me an example of your patient and whānau centric approach to diabetes, other long term conditions and self-management?

From her central base within the Canons Creek community, Alison feels ‘part of the furniture’. ‘I make it my business to be seen in the community, to build relationships and trust.’ Flexibility should be my middle name where access is no barrier’, says Alison with a grin, with a lot of her work done outside of 9-5 hours. Alison feels that one of the keys to success in reaching her clients is to respond when they need it, even if that means being Guest speaker on a Saturday night at a church meeting, at the school fair or a 7am home visit before working parents leave for the day. ‘You name the place’, says Alison, ‘and I’ll be there.’

Alison uses a co-ordinated and a very visual approach to nutrition in simple bite sized messages. ‘I can often be found wielding an enormous tool kit in my trusty suitcase’, which is full of conversational props ranging from supermarket specials flyers, plastic fruit and coloured milk bottle tops.

Alison always has a referral conversation to understand the individual patient and whānau situation prior to a first meeting. With home visits, Alison likes to meet the cook and the shopper of the family as nutritional influencers to the whole family.

A typical patient approach for Alison is to initiate a simple discussion, often starting with ‘what did you eat today?’, or ‘what do you drink when you’re thirsty?’, ‘what colour milk do you drink?’ Through this conversational, patient focussed approach, Alison quickly builds up a dietary picture and works in small steps to reach and agree a more balanced picture with the patient. Conversations are always around the ‘now’ situation and how to get closer to a balance. Goal setting in small steps is a key to success, which might mean asking the question, ‘what’s one of these things you’d like to try over the next few days?’ with a follow up visit or phone call contact in a couple of weeks.

Creating a healthy hangi is one example of how Alison was able to use an innovative, co-ordinated and whānau-centric approach to reach and engage a group of at risk community members A local Marae based community worker contacted Alison with an invitation to a Hangi for a group of overweight men identified within the community. Alison and the Marae group in co-ordination with health care practitioners and community workers, met and worked together to create the healthy hangi.

Starting with the physical act of digging the pit, the group joined Alison in the kitchen for a healthy food discussion, helping to cut off fat from the pork, leaving skin on potatoes and preparing salads and vegetables to add to the traditional menu. Once prepared and laid, Alison took full advantage of the lengthy cooking time and captive audience by holding a physical activity class and asking nurses to carry out blood tests and Diabetes checks for the group. Some hours later the entire whānau arrived and everyone enjoyed eating the healthy hangi together. The group also negotiated a working bee Koha solution, rather than a traditional food based contribution. The group were engaged and enthusiastic about having contributed to the day and enjoyed the comfort of having tests and checks take place in a familiar setting.

Alison says, ‘if you ask people what they want, they usually come up with the best framework to ensure a successful, community appropriate approach to healthcare.’

Susan: What’s the best part of your job?

Alison: A genuine interest in meeting people and hearing their stories’ drives Alison who focusses ‘on people rather than the diseases’. Alison also loves seeing the confidence inspired in nurses who have experienced nutritional mentoring in practice and are using their new skills everday. Alison says it’s an on-going challenge for people to make healthy changes in an environment that’s against them citing the 17 take-away bars and no central supermarket within the socio-economically challenged Canons Creek area.

Susan: What’s your biggest on-going challenge and what support could improve the situation?

‘It’s just me’ says Alison, who would love a team of Dieticians to be available to her community. ‘Obesity and Diabetes are all growing issues, which will soon require more people to be working within nutrition.’ Alison would also love to see a national strategy formed around nutrition.

Susan: What’s your top tip to people who might be new to diabetes or Cardiovascular disease and feeling a bit overwhelmed?

Alison: ‘One small step at a time and celebrate each success. Small changes can make big impacts to your lasting health.’