• Fresh Views

    RESILIENCE: Today’s word to jump-start solution-focused practice

    World Diabetes Day 2020 theme is the Nurse and Diabetes

    “Persistence and resilience only come from having been given the chance to work through difficult problems.” ― Gever Tulley

    Can you believe we find ourselves in the middle of November already? November is diabetes awareness month and the activities and events that take place create an opportunity to heighten awareness of diabetes care, education, and health outcomes. 

    Each year on November 14 World Diabetes Day (WDD) is celebrated, with global themes to improve access to critical medicine, care and therapeutics. This year’s theme is the role of the nurse in diabetes care. In many parts of the world, the nurse is frequently the healthcare professional that helps manage people with diabetes, especially in remote and rural parts of the world with limited health care access. 

     The goals of this year’s WDD emphasis include the following: 

    • to raise awareness of the critical role nurses play in the lives of people with diabetes 
    • to recognize the need for more nurses
    • for nurses to educate themselves about caring for people with diabetes

    You can read more about this year’s activities here.

    We @AFreshPOVforYou want to acknowledge that nurses are especially important members of the healthcare team in the midst of the global pandemic! We see the role that nurses play every day as front line workers and appreciate all they do! For those providing direct care to people with COVID-19…what resilience to get up every day and go into work…not only facing the challenges of day-to-day work, but often acting also as a support person, and at times a surrogate family member. 

    TODAY’S WORD IS RESILIENCE

    This month-long focus on diabetes awareness, brings about the opportunity to touch on one of the skills essential for people with diabetes to develop in order to live well with diabetes. That skill is resilience. And yes, resilience is a skill. We think about resilience as the ability to “bounce back” after challenging times. It’s having inner strength when life throws you challenges and still being able to hold your head up.  

    People who see themselves as being resilient are typically those who have suffered adversity, faced significant challenges and were able to come out of their struggles stronger and with a different perspective on life. Often those who have faced the biggest challenges are the most resilient. Living with a chronic condition like diabetes means living with chronic stress, and that can make managing diabetes more challenging. That’s where building resilience comes into play. 

    While some believe that one is either resilient or not, research shows that resilience is a skill that can be developed over time with practice and support. And when a diabetes care and education specialist – whether a nurse like Deb, a dietitian like Tami, or other diabetes health-care professional – engages in a solution-focused approach to practice, the ability to build resilience is not only possible, but highly likely.   

    When we reinforce and recognize positive behaviors and strengths, people tend to do more of those things more often. In solution-focused practice we call these “exceptions” or times when problems don’t exist and life is working well. 

    In our recent research we learned about resilience. Participants in our study described resilience as strength, optimism, stubbornness and persistence. People acknowledge they have no choice to move forward with diabetes management. One participant acknowledged “stubbornness and persistence. They seem to pay off (sometimes) I’d say resilience too, but that is a moveable feast and very noticeable when absent.” This comment really made us think about the need to support the development of resilience.

    Cultivating resilience is critical in diabetes, especially in those who are not more naturally inclined to recognize their resilience. A friend of Deb’s that lives with diabetes shared a story where she accidentally gave a very large insulin bolus via her pump, almost her total daily dose of insulin at one time. While completely stressed and nervous, she texted Deb who immediately called her to help her problem solve. She spent the next four hours on the phone while eating more carbs than she had in the previous month, but was determined not to go to the ER. She wanted to take charge and manage the situation. So that stubbornness really paid off.  She never went below 70. With the help of her continuous glucose monitor (CGM) and support, she was able to manage the situation. While the day was extremely stressful, she was able to think through her options and what they meant to her. While this situation is unique and not a frequent occurrence, it does help to identify a need for planning for challenges.  A key focus in resilience is on recognizing stressors and building plans to work through the stressful situations and setbacks and come out on the other side feeling successful, even if it is just one very small success.

    EACH WEEK WE INVITE READERS TO PARTICIPATE IN A SOLUTION-FOCUSED CHALLENGE… This week, we challenge you to support your clients to develop their own resilience. Here are 4 ideas to try:

    1. Start all engagements with positive statements with focus on the individual’s strengths and what’s working well for them (even if it’s not directly related to their diabetes management).
    2. Encourage small personal experiments to gain small wins. Every significant step forward towards goals is a step in the right direction.  Recognize and celebrate these small steps. (Such as increasing time-in-range of 70-180 mg/dL from 50% to 55% or fitting in an extra 5 minutes of activity several days).
    3. Encourage your clients to engage in peer support whether in person or online. Help them learn how to seek support from others living with diabetes. Let them know that when they acknowledge their challenges and talk through them, they will often feel a sense of relief.
    4. Help clients to identify their VIPs (very important people in their life) who they can rely on for support.  Sometimes it may be simply someone to listen to challenges.  But, we also need people in our lives that “challenge us” and encourage us to see our true selves. Often we need different support people to play these different roles.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is an employee of Dexcom but all comments are her own.

  • Fresh Views

    NO JUDGEMENT: Today’s words to jump-start solution-focused practice

    Pumpkin Mania at Transylvania University

    Often people who criticize your life are the same people that don’t know the price you paid to get where you are today. – Shannon Alder

    Halloween is just around the corner! Pumpkin Mania at Transylvania University in Lexington, KY (pictured above) always gets Tami in the holiday spirit and ready to see all of the costumes and trick or treaters on Halloween night. (That’s something we both will miss thanks to the pandemic). Halloween doesn’t have to be all tricks and no treats though for those living with diabetes. Many clients with diabetes have shared over the years the “judgement” they have felt and received from others when choosing to enjoy a small Halloween sweet treat or two. Having heard that again just recently, it prompted us to focus on “No Judgement” in this post. 

    TODAY’S WORDS ARE: NO JUDGEMENT

    Stigma and “judgement” are common around diabetes, and can contribute to stress and feeling shame. Receiving negative and blameful comments and judgement, whether through “a look” or through words, has an impact on motivation and behavior. Each member of the healthcare team can play an important role in serving people with diabetes by taking a respectful and inclusive approach. Clients may not even remember all you said to them in the encounter, but they’ll always remember how you made them feel – if you made them feel good or feel bad, if you made them feel valuable or invaluable, That’s where listening and replying  without judgement comes in. What we say and how we say it matters. 

    In fact one respondent’s comment from a #DSMA Twitter Chat we hosted on World Diabetes Day a couple years back has stuck with us: “Success would look like people realizing what diabetes is and we can stop with these assumptions and jokes about diabetes.” So powerful. (By the way, you may want to read more about insights we gained, published this month in The Diabetes Educator journal: “Applying a Solution-Focused Approach to Life With Diabetes: Insights Gleaned via Twitter ” Volume 46, Issue 5 of The Diabetes Educator.  We’re super excited to have these findings published!)

    Putting “no judgement” with a solution-focused approach into practice
    On the topic of Halloween, Tami recalls a client with diabetes she worked with a few years back that absolutely adored Halloween candy, particularly the fun-size chocolate bars. This individual was struggling with trying to manage her carbs, “stay strong”, and “resist” the treats she encountered every time she stepped into the grocery store. And then there were the “after Halloween” sales to navigate when all the treats were 50% off!  She shared that she had learned if she bought 1 bag and kept it out of sight, rather than in a bowl on the counter where she would be reminded of the chocolates, she wasn’t as tempted, but still found herself reaching for the bag more often than she desired. How would you approach this conversation applying solution-focused principles? Tami, acting as her “think partner” spent some time talking with her – no judgement – acknowledging the positive discovery she made and exploring how she could leverage that. Tami rephrased and included the clients own words, “How were you able to decide to keep the candy bag out of sight? What else can you do?” Building on that, the client decided that when she bought a bag of chocolates, she would put the bag in the freezer and only take out 1 or 2 chocolates at a time to help reduce her temptation further. She reported back that this was hugely helpful. Building on her discoveries and areas where she was having some success, helped to discover a new solution and achieve her goals to fit in a favorite Halloween sweet treat without compromising her blood glucose. 

    If you haven’t seen it yet, JDRF has an excellent easy-to-use Halloween Guide with tips on how to keep the holiday fun and safe, along with carbohydrate counts for popular Halloween candies. Helpful information for “kids of all ages”. 

    So whether you choose a low- or very-low carbohydrate eating approach without sweet treats in the mix, or you choose to fit in and enjoy an occasional sweet treat, we hope these real life examples illustrate how others have found success around managing holiday treats, and how to apply a think partner approach with clients in a “no judgement” way, to find solutions leveraging past successes. 

    EACH WEEK WE INVITE READERS TO PARTICIPATE IN A SOLUTION-FOCUSED CHALLENGE… This week, we challenge you to strive to be mindful and consider how you may convey judgement in both words and actions in client interactions. Think about:

    1. The strength, courage, and time it takes for individuals to carry out their daily diabetes self-care.
    2. Using person-first, strengths-based language. (View a previous blog on language here.)
    3. Practicing cultural humility.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is an employee of Dexcom but all comments are her own.

  • Fresh Views

    LISTENING: Today’s word to jump-start solution-focused practice

    The horn sounds as the ferry leaves the port in Edmonds, Washington

    “Listening is often the only thing needed to help someone.” ~ Unknown

    Listening is a crucial skill to hone in all areas of life and things we do, both personally and professionally.

    TODAY’S WORD IS LISTENING

    In solution-focused practice, listening is a critical component of the therapeutic relationship, and the ability to be a “think partner” to the client alongside you. Listening for what’s important to him/her, what areas they’re having success in that you can build upon, and listening for challenges and concerns they may have. With limited time to spend with a client and guidelines or recommendations deemed important to deliver, it can be easy to forget the human aspect, that the client before you is a person too (read our previous blog post about Being Human here). They may be stressed, overwhelmed, angry, grieving, etc. and looking for support and someone to help them find solutions, rather than receive a list of marching orders. 

    A real world example

    Along those lines, an acquaintance of Tami’s recounted a recent interaction at a cardiologist’s office. This acquaintance who we’ll call Carol had developed heart arrhythmia and was sent by her primary care provider to a cardiologist to be placed on a holter monitor for a month to determine exactly what was going on. Carol arrived at one of the large health system campuses having no idea that it would take her 45 minutes of walking to get from her car to the actual office in the hospital complex (coming in contact with more people that she’d come in contact with since the pandemic began!). She finally arrived at her destination, anxious, stressed, and short of breath, to be whisked in a room, connected to and handed the holter monitor, verbally given numerous instructions, and sent back out the door. She shared with Tami that she felt totally overwhelmed when she left, she wasn’t sure exactly what to do, and was extremely frustrated and scared. It seemed that she was “just another number to get in and out of the office”. That human touch had somehow been lost. She felt as if she was just a “problem” to be “fixed.”There was no listening to her concerns or real opportunity for questions. That said, granted, there are many positive healthcare interactions where listening IS a core part of the interaction, however, this scenario struck us as a timely reminder that in many it is NOT.

    Listening can transform interactions

    Over the last couple of years we’ve shared a variety of tips, techniques, and approaches to embrace and employ a solution-focused approach to practice (rather than one focused on “fixing problems.”) Some solution-focused techniques may seem simple…such as encouraging more listening. That seems simple. However there is a strategy in place. When listening from a solution-focused perspective, you listen in the present state while trying to co-create conversations to help your client visualize their ideal future state, and move in that direction. It means looking for cues and clues to identify strengths. Practitioners call solution-focused discussions the “language of change.” When acting as the “think partner”, the practitioner listens for the clients words and meanings that are focused on change. Once identified, the clients own words are then used to move towards generating solution-focused change. Every answer requires continued listening and is another opportunity to identify a potential move towards solutions. It is simply not possible to implement a solution-focused practice without heightened listening skills.

    EACH WEEK WE INVITE READERS TO PARTICIPATE IN A SOLUTION-FOCUSED CHALLENGE… This week, we encourage you to actively focus on listening before speaking with clients. Your conversations will be different than focusing on diagnosing and treating problems. 

    1. Ensure each meeting with a client is focused on their concerns and what is important to them.
    2. Listen for clues and cues that highlight exceptions, current resources and strengths the client identifies. Maybe open the conversation with a simple question, such as, “What’s been going on in your world?” It’s broad, enables the client to take the conversation where they wish, and can provide insight into other aspects and impacts in their life.
    3. As the conversation evolves, use the clients own language to help the client envision their preferred future

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is an employee of Dexcom but all comments are her own.

  • Fresh Views

    COMPASSION: Today’s word to jump-start solution-focused practice

    “Fight for the things that you care about. But do it in a way that will lead others to join you.” – Ruth Bader Ginsburg

    It’s official – summer has come to a close! (At least in our parts of the world). We welcome autumn and the change of seasons it brings. We find that this time of year is a time for reflection for us. A time we often reflect back over the year and look ahead to what the remainder of the year will bring. How about for you?  On the note of fall and reflection, we’re sharing a favorite pic from Scotland in September a few years back with a beautiful reflection of the Highlands in one of the lochs. It’s an image imprinted in our minds! (You can learn more about our perspective on “imprinting” happy memories here.)

    TODAY’S WORD IS COMPASSION

    One topic we think it’s particularly  important to reflect on is COMPASSION. Compassion as a healthcare professional with your clients. Compassion towards others you encounter. Compassion towards yourself. With the recent passing of Supreme Court Justice Ruth Bader Ginsburg, we’re reminded of the impact of compassion. She was someone who had a strong sense of compassion while working to serve the people, a champion for equal rights in all areas of life.

    On a scale of 1-5, how would you rate your level of compassion towards your clients? To others you encounter? To yourself?

    BENEFITS OF COMPASSION

    Evidence suggests that there are actually physical benefits to practicing compassion. People who practice compassion produce less of the “stress hormone” cortisol, experience greater happiness (and thus impart happiness to those around them), and even appear to produce more of a hormone that counteracts the aging process. Good stuff all the way around! 

    The key to developing compassion in your life is to make it a daily practice.

    Compassion can be expressed in many ways; in small acts of kindness, when working with teams at work by respecting everyone’s opinion, and by supporting people with diabetes in their choices.

    4 COMPASSION PRACTICES FOR HEALTHCARE PROFESSIONALS 

    Reflect on recent interactions you have had with your clients with diabetes, and your level of compassion. Compassion in attitude, language, and interactions are core in solution-focused practice. It’s easy to become so focused on delivering pertinent recommendations, in constrained amounts of time, that compassion may unintentionally fall to the way-side.

    In evolving to solution-focused practice, here are 4 different compassion practices that you can perhaps incorporate in interactions with clients:

    1 – Greet each morning with a compassion frame of mind. Take a couple of minutes each morning to focus your mindset on being compassionate. Keep a note where you’ll see it  with affirmations to practice, such as, “Today I am alive. I am going to make the most of it and not waste it. I am going to have kind thoughts towards others. I am not going to get frustrated or think badly about others. I am going to be compassionate to others as much as I can.” 

    2 – Practice empathy. Many believe they have empathy, and on some level nearly all of us do. But many times we get so side-tracked in the client encounter that we may let our sense of empathy slide. In client interactions, try to imagine the challenges, stress or pain they are going through, in as much detail as possible. This moment of mindfulness can help change perspective in attitude, language, and the overall interaction.

    3- Recognize what you have in common. Try to identify something that you may have in common or have experienced when the client is in front of you. At the root of it all, we are all human beings. We need recognition for hard work done. We need caring. We need happiness.

    4- Practice acts of kindness. Practice doing something small each day to make life happier for someone else, even in a tiny way. Imagine that you are the person in front of you, dealing with diabetes challenges on top of routine life stuff. Maybe the act of kindness is a simple smile, a kind word, or just spending a few minutes talking about life (outside of diabetes) with the other person. Find a way to make it a daily throughout-the-day practice.

    Another “reflection” from the Highlands of Scotland on a September day 3 years ago

    PRACTICE MAKES PERFECT

    These compassion practices we’ve shared can be done most anytime, anywhere. Greeting each morning with a compassion frame of mind, can help set the stage for interactions during the day.

    EACH WEEK WE INVITE READERS TO PARTICIPATE IN A SOLUTION-FOCUSED CHALLENGE… This week, we encourage you, at the end of each day, consider taking a few minutes to reflect on your day. Maybe it’s during a commute home, while taking a walk, while fixing dinner, or while getting ready for bed. Think about the people you met and talked to, and how you treated each other. Think about the intent that you started the morning with. How well did you do? What could you do better? What did you learn from your experiences today? 

    Try acting with compassion until you are good at it. With practice, compassion can become an integral part of interactions that you can do throughout the day, throughout life.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is an employee of Dexcom but all comments are her own.

  • Fresh Views

    EXPERTS: Today’s word to jump-start a solution-focused practice

    Today’s word is: EXPERTS

    If you’ve been following our blog, you know that we’re in a series addressing how to move towards a solution-focused practice….one word at a time. This week our word, EXPERTS, applies to both diabetes care and education specialists (DCES) and people with diabetes (PWD). You can read more about STRENGTHS, OPPORTUNITIES, and incorporating the input from experts in their diabetes management here.

    The Association of Diabetes Care and Education Specialists (ADCES) recently published two technology focused papers in The Diabetes Educator journal addressing the role of DCESs in leveraging technology to improve outcomes in people with diabetes. You can find a link to the ADCES landing page here that highlights both papers and includes links to two different podcasts with the primary authors of each paper.

    The Identify, Configure, Collaborate (ICC) Framework

    Deb and co-authors of A Framework for Optimizing Technology-Enabled Diabetes and Cardiometabolic Care and Education document a systematic approach to incorporating technology into the diabetes self-management plan known as The Identify, Configure, Collaborate (ICC) Framework. It is a model to support DCESs to maximize and ensure successful use of technology. We’ll walk you through the 3 components of this framework when incorporating technology into care…

    IDENTIFY: First, identify technology tools that will support self-management and decrease the burden of living with diabetes. It’s important to identify individual bias regarding technology to ensure everyone is offered tools to support them regardless of their age, gender, race and socioeconomic status among others. DCESs are technology champions and can have a big influence regarding technology use. However, we don’t want to be “gatekeepers” denying technology based on our assumptions. 

    CONFIGURE: Once a tool is identified, configuring the settings and plan for use is just as important.  Technology can only improve outcomes if the tools are used to their fullest potential. For example, helping PWD enable alerts and alarms or weekly email notifications when using continuous glucose monitors (CGM)  can help them learn from their own diabetes data in real-time. Mobile apps can be configured to capture patient generated health data (PGHD) that is meaningful to the individual.

    COLLABORATE: Finally, viewing all of the data generated from the technology tools then engaging in collaborative discussions around what the data means and how to make health behavior or medication changes is essential. The DCES is the key team member to support  PWD in the use of technology. DCESs have been focusing on PGHD since the invention of blood glucose monitors and are experts in using data to manage diabetes. And, the use of PGHD can support PWD as experts in their own diabetes as they learn how  food choices, activities, stress, and medication, among other things affect them.

    When incorporating a solution-focused approach into practice, the client is recognized as the expert in their own life and their own diabetes. Clients already have the resources and strengths to move forward to achieve their desired future state. When considering incorporating technology to support diabetes self-management, begin by acknowledging PWD as EXPERTS, prior to identifying and configuring tools, and then collaborating to modify the treatment plan. Create an opportunity to learn from your clients and discuss the value and benefits technology has provided them, as well as the challenges and burdens. This collaborative discussion can help all of your clients as technology evolves.

    Each week we invite readers to participate in a solution-focused challenge. Our solution-focused challenge for this week is to focus on your clients as the experts when incorporating technology and applying the ICC Framework.

    1. Identify and highlight the client’s strengths, positive qualities, resources, and ability to generate solutions prior to suggesting technologies.
    2. Configure technology tools that focus on the details of the solution instead of the problem.
    3. Collaborate to develop action plans that support what is working well for the individual.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is an employee of Dexcom but view here are her own

  • Fresh Views

    JOURNEY: Today’s word to jump-start solution-focused practice

    A journey of a thousand miles begins with a single step.” – ancient Chinese proverb

    Tami and Deb with our friend Karen Kemmis ready to head off to the Kentucky Derby a few years back


    This Saturday September 5 marks the 146th running of the Kentucky Derby! If you are not familiar with this premier thoroughbred horse racing event, it is held annually in Louisville, KY, typically on the first Saturday in May. Yet, due to the pandemic, this year’s Derby was moved to the first Saturday in September in hopes that this “Fastest Two Minutes in Sports” would have an excited crowd cheering on the three-year-old thoroughbreds as they raced the one and a quarter miles to the finish line. The stands typically would be teeming with spectators from around the world oozing with fashion…ladies sporting beautiful dresses and big hats and men decked out in colorful suits…yet this year the stands will be empty. This race is often called “The Run for the Roses” because a blanket of roses is draped over the winning horse. It is the first leg of the American Triple Crown, followed by the Preakness Stakes and then the Belmont Stakes. A horse must win all three races to win the Triple Crown.

    Our husbands sporting their sharp Derby attire

    Not only is this premier horse racing event near and dear to our hearts since we had the opportunity to experience it a few years back, it causes us to take pause and reflect on the JOURNEY to qualify for the “Run for the Roses”.

    Some horses are born with talent, and are simply stronger and faster than other horses in the race. They are considered the “favorites” to win their races. But yet, the “favorite” doesn’t always win every race. Sometimes the winner is a horse with lesser talent so to speak, but who has a trainer that’s able to help maximize the horse’s potential through customized training based on the horse’s particular strengths and weaknesses, and by leveraging factors such as weather and track conditions, to give the horse the desire and best chance to win.

    As is the path to the Kentucky Derby a JOURNEY, without a doubt living with diabetes is a JOURNEY too.

    Today’s word is JOURNEY

    This journey brings not only glucose ups and downs, but twists and curves based on life’s experiences and challenges. When working with clients facing diabetes challenges, it’s key to focus on where they are in their journey and the complex decisions and choices they make on a daily, hourly, and even minute-by-minute basis. 

    We’ve shared before our fondness of Taxonomy of the Burden of Treatment paper (Tran et al) which helps clarify in a visual way the complexity and work required to manage a complex chronic condition like diabetes. When thinking about where clients are on their journey with diabetes, consider all of the factors that are impacting their decisions, choices, opportunities, and challenges. We can be supportive by helping them focus on their strengths, successes, and resilience. Just identifying one thing that is working well for them or finding an area in their life where their hard work is paying off can be incredibly impactful. 

    How often are people with diabetes recognized for the work they do?

    During one presentation at the Association of Diabetes Care & Education Specialists virtual annual meeting the current ADCES Diabetes Care and Education Specialist of the Year, Dr. Diana Isaacs, made a profound statement that resonates with a solution-focused approach: 

    In her practice’s shared medical appointments where participants wear a continuous glucose monitor (CGM), she starts off by thanking everyone for wearing the CGM for the week and recognizing the achievement in doing so. A thank you…it sounds simple, but is so powerful. How often are people with diabetes  recognized for the work they do? Diana focuses on what worked well for them during their week, and asks permission to discuss their challenges. During the session participants are able to focus on the journey of learning how they can make decisions and changes moving forward, based on their discoveries. No matter how small the changes may be, small steps add up.

    What an impactful way to make education meaningful and individualized, with the DCES stepping alongside as a “think partner” helping them take the next step on their journey. 

    As we shared in this blog around Derby time last year, when a client is faced with a scenario they’re trying to sort out, here are 3 key questions you can ask as their think parter:  

    1. What’s going well?
    2. How did you accomplish that?
    3. How can you do more of that? 

    Each week we invite readers to participate in a solution-focused challenge. This week we encourage you to:

    1. Start each session with a client by acknowledging the hard work they are doing managing their diabetes, even if it’s as simple as a thank-you for attending the session.
    2. Discuss with clients the concept of living with diabetes as being  a journey where there is always opportunity to shift directions.
    3. Offer clients support on their journey by sharing resources on peer support groups, either in person or online. Learning how others are moving forward living with diabetes can be life changing. 

    Try out one or more of the strategies we’ve shared, and reach back to  let us know how you’re doing! We’d love to help you de-stress and focus on a positive mindset.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is an employee of Dexcom but all comments are her own.

  • Fresh Views

    HUMOR: Today’s word to jump-start solution-focused practice

    Laughter is an instant vacation. – Milton Berle

    Given the stress, anxiety, and chaos that COVID-19 is still raining upon the world, we’ve been looking for opportunities to laugh and find humor in our everyday world. Earlier this week, that came in the form of a virtual happy hour (pictured above) with dear colleagues at the close of the Association of Diabetes Care and Education Specialists (ADCES) virtual meeting. A special shout out to Lorena Drago for being the “hostess with the mostest” and donning a blonde wig and festive party attire for the celebration! 

    You may be super busy these days and have many things on your mind, so we’re hoping today’s blog can help you take a short stress break, identify personal opportunities to laugh, and consider how you can look for moments to incorporate humor in encounters with your clients and diffuse stressful conversations.

    Today’s word is HUMOR: 

    Finding humor and laughter in the everyday world is a key opportunity to reduce stress. Personally, we often feel rejuvenated and ready to face the world again after a good belly laugh or a few silly moments. Suddenly the weight of the world is lifted off our shoulders. 

    Research has shown that not only can humor reduce stress, it can decrease anxiety and fear, and help people cope with challenging situations. Humor can instill a more lighthearted perspective and make challenges seem less threatening. Laughter increases hormones in the body that reduce stress, decrease pain, and can even improve the immune system by supporting T-cell development. Humor can instill a sense of power, especially during times when feeling powerless. In fact, we have documented through our research that humor increases resilience in diabetes management and is a key factor to living well with diabetes. You can read more about the research findings in our recently published research paper, Applying a Solution-Focused Approach to Life With Diabetes: Insights Gleaned via Twitter published in July in The Diabetes Educator journal (). In the study, laughter and humor were described by all participants as essential for overcoming the burden associated with living with a serious chronic condition.Strength and resilience were often equated with a sense of humor when faced with challenging situations

    Here are 5 ways that we have been finding opportunities for humor which we hope may spur some ideas for you and that you can suggest to your clients:

    1 – Get together and laugh with friends: Whether this is via Zoom or in a social-distanced driveway happy hour. Fun virtual backgrounds can add laughter for virtual gatherings.

    2 – Social Media cartoons, memes and videos: We have a couple of friends that also help us start each day with a funny cartoon or meme posted on Facebook. We look forward to that chuckle as we head off to our home office for work. Taking a mid-day break and searching for a good laugh is also good medicine. 

    3 – Binge watch comedy shows: Like Deb, you may have older kids home again with many schools and colleges being virtual. Deb’s found that watching old shows with her daughter has been a great bonding experience and opportunity to laugh. The current binge is Gilmore Girls (now up to Season 3).  Any suggestions for the next show?

    4 – Smile every day,  even when it’s hard: Starting the day off with a smile can help impact your mood.  You’ve heard the old saying “Fake it until you make it.” Well, saying that you’re going to have a good day and find humor in your day can really make a difference.

    5 – Laugh at yourself: If you tend to take everything very serious, especially these days, finding ways to relax a little and laugh at mistakes, misfortunes and circumstances can make life easier. Laughter connects us with others and most people find that laughter is contagious. The picture below candidly caught us sharing contagious laughter a few years back. This photo still makes us smile and is a gratitude reminder everytime we look at it. You can learn more about gratitude reminders in our post here and about Finding Joy in our post here.

    Each week we invite readers to participate in a solution-focused challenge. We encourage you to ask your clients this week what they have been doing in their life to find opportunities to laugh! Discuss with them that finding humor in the everyday world is healthy for them both physically and mentally.  If you are doing telehealth meetings and you see something that makes a person unique in their home, maybe you can ask them to tell you about its significance, maybe there is a light hearted story to tell. 

    Try out one or more of the strategies we shared today, and reach back to  let us know how you’re doing! We’d love to help you de-stress and focus on a positive mindset.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

  • Fresh Views

    ADCES 2020 goes virtual: 8 sessions you don’t want to miss!

    Tami & Deb at ADCES 2019

    With the Association of Diabetes Care and Education Specialists Annual meeting (formerly AADE) right around the corner, we’re taking a brief break from our solution-focused word of the week series to highlight some of the sessions that will be presented at the ADCES meeting on psychosocial and behavioral health and technology. They align with our thinking and approach, and we thought might be of interest to you too. 

    This typically in-person meeting is always one of our favorite times of the year! It is such a great opportunity to reconnect with friends and colleagues while being energized about the work we do in diabetes care and education. However, in light of the pandemic, this year’s meeting (like many others) has gone virtual. So it is with mixed emotions that we share this ADCES preview. While we  look forward to learning from colleagues in the comfort of our homes this year, we so wish times were different and we could share coffee or lunch together, catch up on everyone’s lives over a glass of wine, give a lot of hugs, and dance the night away at the annual Sunday night dance party. Especially for the two of us, we have not been together in person since last October. One of our hopes in collaborating on this blog together was that we’d have the opportunity to spend more in-person time together. While we engage via Zoom, it’s just not the same.

    We’re excited to share that  we had an abstract accepted to present as an oral session at the originally scheduled in-person meeting in Atlanta on “Flipping the Paradigm: Applying a Solution-Focused Approach to the AADE7 Self-Care Behaviors”! But due to the condensed nature of the virtual meeting we opted out, with the hope that we can share our full presentation next year (fingers crossed!). In the meantime, we’ve had our first research paper incorporating a solution-focused approach published! You can find it online, Applying a Solution-Focused Approach to Life With Diabetes: Insights Gleaned via Twitter. This paper resulted from our presentation at the European Association for the Study of Diabetes last fall. We report the findings of our online study where we employed the Miracle Question approach during a Twitter chat. 5 themes evolved of a desired future state: more of living life; laughter and humor; self-compassion; resilience; and support.  

    Here are 6 of the sessions of interest that you may want to check out (all times are central time zone): 

    GS02 – Mobilizing for Health Equity (Friday, Aug 14 9:00 AM, 1 hour)

    This session will provide the participant with an understanding of the history and impact of structural racism on health equity. Throughout the presentation, Dr. Blackstone will define structural racism and how it relates to the social determinants of health. The participant will leave the session with key strategies to make individual steps toward interacting with equity.

    F06 – Empowering African Americans With Diabetes Through Positive Thinking (Friday, Aug 14 2:05 PM, 30 minutes)

    African Americans face many challenges associated with diabetes self-management and it is common for them to fall into negative thinking patterns. Researchers suggest that positive thinking can lead to improved diabetes management and empowerment to foster independence, self-management and the ability to question and make informed choices. This presentation offers 6 positive thinking strategies that can be utilized to assist in empowering the African American participant.

    F05 – Integrating Diabetes Technology Into the Clinical Paradigm (Friday, Aug 14 1:00 PM,  (1 hour)

    New and emerging technologies can help people with diabetes optimize glucose levels, reduce diabetes burden, achieve improved quality of life, and reduce the risk of acute and chronic complications. Diabetes care and education specialists and clinical practices are struggling to keep up with the pace of technological change. While essential, expertise in diabetes technology is not enough. There must also be processes in place to streamline paperwork and documentation, optimize clinical flow, educate staff and providers, and obtain reimbursement. This session will provide an overview of how diabetes technology can be effectively integrated into the clinical paradigm and discuss the role of the diabetes care and education specialist as the clinic’s technology expert and champion.

    F12 – COVID-19 Update: Protecting Adults with Diabetes (Friday, Aug 14 3:45 PM, 30 minutes)

    A significant portion of the U.S. population is vulnerable to severe complications, including death, from COVID-19. In addition, social disruptions secondary to the pandemic response are creating new vulnerabilities in the provision of chronic disease care and self-management for non-pandemic illnesses. This presentation will expand foundational knowledge of the impact of COVID-19 on people with diabetes and provide strategies through education and technology to protect adults with diabetes from COVID-19 while reducing gaps in diabetes care and self-management.

    S06 – Diabetes Psychology and Diabetes Services: Similarities and Differences (Saturday, Aug 15 10:40 AM, 30 minutes)

    This presentation will explain how diabetes psychology is used to help people implement new behaviors, navigate social stressors and manage the feelings of anxiety, depression and stress that often accompany diabetes. A discussion of similarities and differences between diabetes psychology and diabetes services will be provided. A model for integrating diabetes psychology with diabetes services will be described with examples of implementation at the San Diego VA hospital.

    D09 – Using Mindfulness in Veterans to Lower Diabetes Distress (Sunday, Aug 16 12:05 PM, 30 minutes)

    Mindfulness benefits veterans with depression and PTSD, but little is known about the impact of mindfulness in those with diabetes. This presentation will share our experiences and participant perspectives of a mindfulness-based diabetes education intervention that utilizes a digital application to support daily mindfulness in everyday life. Additionally, we will examine associations between mindfulness, diabetes distress (DD), stress-related symptoms, and glycemic management (A1C) and show how incorporating a mindfulness intervention into DSMES can target both DD and A1C in at-risk populations.

    Also, check out Deb’s 2 research presentations, one oral and one poster:

    F03C – 12-Month Outcomes for a Behaviorally-Enriched Diabetes Prevention Program for State Employee Commercial Drivers

    Not all participants achieve DPP outcomes. Identifying opportunities to augment, enrich and enhance the traditional program are needed to meet individual needs.  This session will present data from a 12-month observational study that evaluated the effectiveness of an innovative, behaviorally enriched  Diabetes Prevention Program (DPP), on program outcomes of attendance, weight loss and physical activity.  This innovative, coach-led, behaviorally-enriched DPP was designed specifically to engage and motivate a “hard to reach”, mobile population at risk for developing type 2 diabetes using a behavior and social assessment and decision support tool set to facilitate a practical behavior change model (Information, Motivation, Skills) integrated into routine team care delivery and clinical software applications. Note: Sarah Downs and Alyssa Griswold contributed as co-authors on this submission.

    P409 – Diabetes Education Through Peer Support for Hispanic Spanish Speaking People with Type 2 Diabetes

    Diabetes is twice as likely to affect Hispanic people than their Caucasian counterparts. Our previous community-based participatory research demonstrated that technology in addition to social support is necessary to effect diabetes-related behaviour change in Hispanic individuals with type 2 diabetes (T2DM). In this feasibility study, we address gaps in diabetes care for Hispanic people with T2DM by combining technology with an online peer support intervention. The inclusion of Hispanic, Spanish-speaking peer facilitators with diabetes lived experience will enable culturally appropriate discussion, advice and strategies to enhance the use of CGM and improve diabetes outcomes in participants. This poster presentation will describe the study background, methodology and intervention protocol.

    Also, please consider attending the Dexcom Educational Theater on Thursday, August 13, 2020 at 2:45 pm CT, Lighting the Fire: Bringing DSMES to Life with CGM with Dr. Bill Polonsky and Dr. Diana Isaacs. During this session, Dr. Diana Isaacs incorporates solution-focused principles when discussing CGM data with her clients.* This program is open to anyone whether attending the conference or not. You can register here.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    *Note: Deb is employed by Dexcom but anything posted on this blog is her personal opinion.

  • Fresh Views

    SOCIAL WELLNESS : Today’s word to jump-start solution-focused practice

    With the United States slowly reopening, many are longing to physically be in the presence of family and friends, and are fatigued with virtual “gatherings” (ourselves included!). The very thought of even a small physically-distanced in-person gathering brings joy! After all, these summer months typically abound with backyard barbecues, family reunions, and pool parties. 

    Research has shown that these types of interactions are not only fun, but healthy too – helping people stay healthier both mentally and physically. They contribute to what’s known as “social wellness”. Fittingly, July is Social Wellness Month.

    Many people with diabetes, parents and children with diabetes spent last weekend engaged in social wellness by participating in the Virtual Friends for Life conference. Normally in Orlando every July, this meeting is so unique and so important for the many families that attend. At the meeting people wear a green bracelet when they have diabetes and an orange one if they do not. Tami used to serve on the Children with Diabetes board and we’ve both attended the conference several times and guarantee that it is a magical event. Especially when you see young children making “friends for life” with other kids, just like them, sporting their green bracelet, living with diabetes. While a virtual format does not allow for the connections that are made in person, there were many opportunities to have fun, dance, learn and “meet up” in the virtual hallway. People were doing their best to stay connected.

    Today’s words are: SOCIAL WELLNESS

    What is “social wellness”? Social wellness refers to building positive, supportive, healthy relationships that can offer support during challenging times. Support comes in many forms. In this blog we share 5 ways to guide your clients to engage in ongoing diabetes support. In case you’re wondering what exactly are hallmarks of  a “healthy” relationship, here are signs to consider:

    • feeling good about yourself around your friend, family member, or partner
    • feeling safe talking about how you feel, 
    • feeling listened to, and valued, and truly experiencing mutual trust

    Social wellness is now receiving greater focus and emphasis from the medical community. It is a critical aspect of overall health. Through research and focus groups that we’ve conducted with people with diabetes, we’ve heard time after time the critical nature of fostering a genuine connection with others with a lived experience. Strong and healthy social connections and networks are associated with the following:

    • blood pressure and heart rate that respond better to stress 
    • a healthier endocrine system  
    • enhanced immune system’s ability to fight off infection 
    • a more positive outlook on life
    • longevity

    In the quest to help people with diabetes be their healthiest self, here are 2 strategies for improving social wellness that you may want to explore with your clients::

    Strategy 1- Make Connections. Come alongside your clients to identify ways to find new social connections, particularly in these socially distanced days. Here’s a few ideas: 

    • Join an online group focused on an interest or hobby, such as painting, great hiking spots, or an online book club. 
    • Expand horizons by taking virtual music lessons, using a cooking app to learn how to make new recipes, or finding a recipe that you can prepare on zoom simultaneously with a friend.
    • Participate in a neighborhood event, such as a driveway happy hour with neighbors sitting in their own driveways, or walk by “concerts” where musically talented neighbors have mini “concerts” in their front yard or on their balcony.

    Strategy 2 – Build Healthy Relationships. Making connections doesn’t mean one has arrived. Relationships require work and nurturing to build strong bonds. Here are a few areas you can explore with your clients: 

    • Share feelings honestly and respectfully
    • Ask for what you need from others
    • Be caring and empathetic
    • Decide what you are and aren’t willing to do
    • When compromise is needed, try to find a compromise that works for all involved

    THIS WEEK’S SOLUTION-FOCUSED CHALLENGE

    Each week we offer a solution-focused challenge that can help evolve care and education in a solution-focused manner. Here’s this week’s challenge: Consider asking some of the following questions the next time you engage with your clients to help identify their existing resources to move towards social wellness.

    1. What do you do for fun?
    2. Who do you enjoy spending time with? What makes that time enjoyable?
    3. How do you show the people in your life that you care for them?
    4. What would the closest person to you say is their favorite thing about you?
    5. What are you most proud of about yourself?

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

  • Fresh Views

    OPPORTUNITIES : Today’s word to jump-start solution-focused practice

    Every accomplishment starts with the decision to try ~ Author unknown

    Deb’s new hummingbird feeder creating opportunities to catch an up close view of these beautiful tiny birds

    In this new virtual world, Deb had the opportunity to attend the virtual American Diabetes Association (ADA) Scientific Sessions, from the comfort of her home office! While we @AFreshPOVforYou really enjoy the social aspect of attending in-person conferences, Deb embraced this virtual opportunity and found some interesting presentations.Today we want to focus on and share with you one particularly outstanding session.

    Today’s word is: OPPORTUNITIES

    If you follow our blog, you know that we’re in a series which addresses a client-focused approach to a solution-focused practice word each post. So we want to think about today’s word OPPORTUNITIES in relation to diabetes care and education specialists embracing some learnings from ADA Scientific Sessions.

    One presentation in particular that garnered much attention was the ADA’s 2020 Diabetes Educator of the Year Award Lecture by recipient Dr. Bill Polonsky. His lecture,Tedious, tiresome and dull’: Strategies to improve diabetes self-management education” was thought-provoking and insightful. Dr. Polonsky stressed that diabetes care and education specialists need to make education meaningful to those living with diabetes, and it can’t be focused simply on a checklist of content. We are of like mind as Dr. Polonsky, and believe there are new opportunities to engage with people with diabetes. Rather than working through a list of content that may or may not be relevant to your client, why not incorporate a solution-focused approach, and turn attention to the individual, their needs, their skills and strengths they already possess. This solution-focused approach is one OPPORTUNITY to address the challenge of “tedious, tiresome and dull education”.

    To spur thinking about different opportunities you can create in your practice to make diabetes self-management education and support meaningful, we want to share 3 of our previous blog posts:

    1. Co-design. Last April we discussed the concept of “co-design” and how gaining input from people with diabetes around the content and structure of diabetes services is critically important. You can read about co-design here.  
    2. Strengths-based language. In 2018, we wrote about using person-first, strengths-based language here. We continue to believe that this practice is essential for successful diabetes care and education.  
    3. New perspectives. In September 2019, we shared a glimpse of our presentation at the international European Association for the Study of Diabetes (EASD) conference. We began that post with this quote by Marcel Proust, “The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.” We’d like to encourage fellow health care professionals to “have new eyes” in relation to diabetes management, and be open to new tools and solutions.This different view through “new eyes” may lead to creating incredible, innovative and visionary opportunities to evolve diabetes self-management education and support services.

    Our solution-focused challenge for you this week is to start each session with your clients by doing one solution-focused activity to create new opportunities.  Here are a few examples:

    Ask your client:

    • What would need to happen to make your meeting valuable to them?
    • What 3 questions do they want to discuss today?
    • What strengths do they already have that you can build upon today?

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

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