• Fresh Views

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

    The strength in the Dolomite Mountains towering over a lovely placid lake in Northern Italy from Deb’s travels in 2018.

    We find ourselves in the middle of National Words Matter week. Did you know there was such a week? Words are the basis for communication, no matter what language is spoken. Because words matter, we’ve written about the #LangaugeMatters movement many times, you can read more here and here. Here at AFreshPOVforYou, we embrace the importance, power, and impact of words, not just this week, but all year long!

    Our series focusing on words to inspire solution-focused thinking and practice continues this week. You can read more about our take on the power of word selection here. Last week’s word was “Acceptance” – check out our perspective here.

    Today’s word is “Strengths”

    According to the Miriam Webster Dictionary, “strength” is: the quality or state of being strong : capacity for exertion or endurance: a strong attribute or inherent asset. In solution-focused talk, “strengths” are tasks or actions an individual can do well. For instance, seeking support. In a 2018 #DSMA Twitter Chat we asked participants about their strengths. One individual with diabetes replied:

    “I am strong when it comes to seeking support. When I am down, I am self-aware enough to address my hardship. I’m not afraid to be vulnerable.”

    Another replied:

    “My strength is that I refuse to give up. I am tenacious and do not take no for an answer.”

    An individual typically can recognize and clearly identify things they are able to do or achieve and feel happy. We can then encourage focus on those strengths, doing more of what is working, and leveraging those strengths, skills and qualities to create new opportunities. In the same Twitter Chat mentioned above, another participant shared:

    “I concentrate on the lifestyle. The day to day life of a person with diabetes. I work for overall health through exercise, and diet for BGL [blood glucose] results. The support I receive takes care of the rest. So, cure or not, let’s make it as good as we can and support the other.”

    We’ve learned that sometimes self-identified strengths are not areas we might immediately think of in the healthcare world, as evidenced by this individual’s reply:

    “My strengths are passion, humor, and striving to connect with the human being that is each of us. And reminding myself I’m a work in progress.”

    Diabetes care and education specialists can learn a lot from simply asking people what strengths they have to help them live well with diabetes. Those words speak volumes, as evidenced in this individual’s reply:

    “I have the strength to keep on going even [when] I have a few bad readings here and there.  I keep living and doing what I do.”

    The Association for Diabetes Care and Education Specialists (ADCES, formerly AADE) embraces using strengths-based language in diabetes care and education, and has a page of resources here that you may find helpful. 

    A solution-focused challenge

    So our challenge to you this week is to focus on using strengths-based language in your communications to help uncover strengths your clients have. And encourage them to build upon those strengths to do more of what is working for them.

    Here are 5 solution-focused questions you can incorporate to focus on strengths:

    1. What strengths do you have and use to help you manage your diabetes every day? 
    2. What other strengths can you identify? (Note: whenever possible we ask “what else” to expand the thought process)
    3. What would success look like for you (e.g. in life, in living with diabetes etc.)?
    4. How can you use your strengths to create opportunities for success?
    5. What else would you like to share with me 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

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to Mobile Apps

    “You`re only as weak as you let yourself become, and you`re only as strong as you allow yourself to be.”

    Daniel Hansen

    Beautiful bougainvillea, Palm Desert, CA

    In this week’s installment of Diabetes Technology and Solution-Focused Practice we’re discussing mobile apps. In our last blog we focused on using a solution-focused approach to interpreting and discussing continuous glucose monitor (CGM) data. This week’s blog we’ll focus on a new discovery for us – the WW mobile app. We will share insights on other apps in future blogs. We believe that using solution-focused language within mobile applications can improve user engagement with the app, as well as encourage individuals to make progress towards their health behavior goals.

    WW App: Deb’s experience…

    As you may know, Weight Watchers is now known as WW. I have been using their app, the WW app, to help  stay on track during the COVID-19 lockdown. You can learn about the different WW programs and pricing here. There are several options to choose from, I only use the app for logging and motivation.  I was encouraged to continue using the app because of the nature of the messaging. Then I began to wonder if they were incorporating a solution-focused approach? 

    From a weekly in-App push a few weeks ago, the headline was “Why you should do what works: You might already have more tools in your toolbox than you think.” If that doesn’t sound like solution-focused messaging, I’m not sure what does! The post reminds us that people typically focus on what isn’t working well and how to deal with challenges. Of course, that is not motivating, and not helpful when trying to make hard health behavior changes.

    But, what if you “Flip the switch” so to speak? (See our many blog posts from 2019 about “Flipping the paradigm” –  here’s one on healthy eating, and here’s one on healthy coping). The WW message goes on to encourage focusing on the things that come naturally and leverage strengths or what’s worked in the past! Wow! We’ve written about strengths in this blog multiple times (you can read about strengths here), and so believe in focusing on what one does well,  building confidence, and increasing happiness by doing so. 

    Make Strengths your Secret Weapon. According to WW, leveraging your strengths will help you be successful. They suggest asking 3 questions to uncover strengths:

    1. When do I feel like my best self?
    2. What makes me unique?
    3. What comes most naturally to me?

    Those are questions that diabetes care and education specialists (DCES) can easily incorporate into diabetes-related conversations with clients as well. Once those questions are answered, WW suggests creating an “affirmation” to help remember to focus on personal strengths. You can read their post here. One exercise that helps people think through writing their own affirmation includes showing a word cloud to help direct thinking about potential ideas of strengths (including humor, cleverness, bravery, creative etc.). What a powerful visual tool, that would be so easy to employ in any diabetes care and education program! Finally they suggest saying the affirmation out loud every morning or posting on your computer so it will be visible every day. For instance, “I am strong.” “I am resilient.” You get the idea

    I loved this way of thinking about making healthy choices, and reading and engaging with the content. I created my own affirmation and have it posted on my computer with a sticky note so I  glance at it multiple times during the day! Tami has affirmations on her desk and in the kitchen that she sees when making coffee in the morning to start the day off.

    Helping clients create their own affirmation using solution-focused principles is a great opportunity to highlight what is working well already and focusing on their strengths, as well as supporting the development of resilience. 

    Do you recommend mobile apps to your clients? 

    If you have a client interested in weight loss or adopting healthy eating habits, the WW mobile app might be a good option. (We are not endorsed by WW and do not receive any compensation from WW). Knowing the positive strength-based language that is being used is so encouraging. Also of note, WW recently hired Adam Kauffman, formerly of Canary Health,  to head their diabetes program (read the press release here) so we’re excited to see what’s to come in the future.

    We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!

    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. 

    Deb is employed by Dexcom but her words and opinions in this blog are her own. Tami is employed by the University of Kentucky Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Top 10 Things 2020 Taught Us

    We were happy to see the sun set on 2020! 

    Life is not about how fast you run or how high you climb, but how well you bounce. – Vivian Komori

    It’s been said that “Life is not about how fast you run or how high you climb, but how well you bounce.” That pretty much sums up 2020! We’ve all learned to “bounce” through the multitude of challenges before us this past year. Yet, through it all there were many positives that we @AFreshPOVforYou personally realized during those unprecedented days. And one of those positives was celebrating the second birthday of this blog!

    WHO ARE WE? 

    If you are new to our blog, we are solution-focused diabetes care and education specialists. We are passionate about doing diabetes care and education differently. Too much of life is spent focusing on problems. Instead, we believe in turning attention to possibilities, opportunities, and a fresh vision for the future. We see the benefit in stepping alongside our clients as “think partners” to focus on what’s important to them, what’s already going well, and build upon that to reach their goals so that they may live life to the fullest. We invite you to join us in doing the same if this is a new paradigm for you. We are advocates for person-centered, strengths-based language, and believe that self-compassion is essential when living with a chronic condition. 

    OUR MISSION

    As we welcome the new year, our Mission continues to be that We guide healthcare professionals in taking a solution-focused approach to practice to enable clients with diabetes to embrace possibilities, opportunities, and a fresh vision for the future.

    Our interest and passion around taking a solution-focused approach to practice (and life), means acknowledging what has gone well, acknowledging how that success was achieved, then identifying how to do more of that and build upon that moving forward.

    TOP 10 THINGS THAT 2020 TAUGHT US (in no particular order)

    1. Importance of connection with others and having support. We don’t take the human touch for granted after living through 2020. We learned that connection and support comes in many different forms. We found creative easy ways to Keep Friends Close, as well as family, through Zoom virtual happy hours, virtual graduations, virtual birthday celebrations; hugs through windows; and drive by celebrations. Find 5 ways to guide your clients to engage in ongoing diabetes support here.
    1. Do hard things early in the day to feel accomplished. We both work the best in the morning. While we’ve known this, it was never quite so clear as it was in 2020. We did the “hard” work early in the day when our minds were freshest, so that we felt accomplished. The stressful days left us tired and spent by days end, and after dinner to help us relax and “escape” we could often be found indulging in Netflix, Prime, and others (who knew you needed so many streaming channels?). We identified a time when things were working well (in the morning) and tried to do more of it. When working with clients, try to identify when they think the clearest and encourage them to focus on their diabetes at that time. Help them identify their “Exceptions”, those times when things are going well. If your client wears a CGM, help them identify a quiet time to retrospectively review their CGM reports to identify patterns and trends and develop 1-2 small behavior changes to move then towards their goals by “doing more of what is working well.”
    1. We CAN be healthy. While many have gained the “COVID 19 pounds”, and may have been over indulging during the past several months, we learned that we could continue to adopt healthy habits, even during a stay at home order. Deb likes and has been focusing on the Mediterranean eating plan that includes lots of healthy fruits and vegetables with less red meat. She also decided to go back to using her WW (formerly Weight Watchers) app to help her track her food, activity and sleep. Tami purchased an under desk elliptical machine to help keep her active during the week, and spent time enjoying great outdoor walking trails on the weekends while social distancing. While in ways it has been challenging being home so much, we learned that it can also be healthy. When eating at home there’s more control over the ingredients added to recipes. There also may be a little more time to prepare meals, or do “meal prep” for the week. Read more tips here.
    1. There are many possibilities, we just have to identify them. With restaurants closed and outside entertainment challenging, we quickly began to think of out of the box possibilities. Deb and her husband decided to have a “car picnic” after they picked up wine at a local winery. From the front seat of their car they could see the peaks of the Sierra Nevada Mountains while enjoying a picnic lunch and a cool glass of Rose. On the work front, taking a solution-focused approach to diabetes care and education can be a fresh new start and bring possibilities to light. Gather some tips from our blog here.
    1. Keep a mindset focused on finding solutions (rather than focusing on problems). We learned that in matters big and small, diabetes-related or not, by embracing a mindset that focuses on solutions, and channeling energy into leveraging strengths and possibilities, we can cultivate a solution-focused mindset. One that envisions success. One which helps manage stress. In our blog you’ll find 7 strategies you can use to step alongside your clients and support them in embracing a solution-focused mindset and managing stress.
    1. Acceptance and gratitude. While social distancing and stay at home orders in 2020 kept us from living out our plans for the year, we eventually came to accept that, and focus on what we could do and find gratitude and happiness in that. Read our tips on developing acceptance as a personal strength and helping cultivate it in others in our blog here, and tips to get started with daily gratitude practice here.
    1. The joy in giving. With life moving at a little slower pace, Tami found joy in giving to others. Small surprise “porch drops” on family and friends’ porches to brighten their day. Dropping by bags of food to be distributed to those in need in the community. She even took up baking bread as surprise drop-offs to those who would enjoy it. With the news coverage of families without food, Deb’s family and her workplace donated to www.feedingamerica.org on multiple occasions to support those in need. Sparking Joy in life and in diabetes education is an important element of our mission.
    1. Active listening is critical. With our daily Zoom meetings and family gatherings we learned that listening is crucial. It can be challenging to not “talk over” people when the virtual conversation includes many individuals. We couldn’t have “side bar” conversations unless they were by text or personal chat. We couldn’t read body language easily. Read more about how listening in a solution-focused practice can support the process of becoming a “think partner” with your clients.
    1. Resilience can be developed. How many virtual conferences or meetings have you attended in 2020? We attended more than we can count, and who knew just how successful they could be! While we missed the ability to be face-to-face with our friends and colleagues, we appreciated the opportunity to continue to learn and conduct business. We just kept going! That is what resilience is all about! Learn how you can build resilience in our blog here.
    1. Power of humor. How could we have survived the past year without humor! Laughing with friends online, reading silly memes on social media, and trying not to take ourselves too seriously. One of our dear colleagues and friends always provides us with comical relief and was no exception in 2020. You can sample our thoughts on humor in our blog here.
    Virtual happy hour laughs!

    2020 was a good teacher! Let’s embrace 2021 with New Year’s “solutions”, rather than “resolutions”

    Our challenge to you as we embark on this new year still facing struggles and uncertainty, is what if, instead of making New Year’s Resolutions this year (which require change and “fixing problems”), you instead guide your clients (and yourself) in making New Year’s Solutions? Who doesn’t like a solution after all? One way to identify solutions is to focus on things that have gone well in the past, and pinpoint how you can do more of that (rather than trying to change). One of the benefits of focusing on what went well, is that you can do it every day. Instead of dwelling on what you didn’t accomplish today, identify what was successful and try to do that “one thing” again tomorrow.

    WHAT’S TO COME? 

    Throughout 2020 we launched a series of posts, each revolving around a “word of the week” to inspire solution-focused thinking and practice. We embrace those words in practice and hope that you’ve found them impactful in your conversations too. What will we write about in 2021? Here are some of our ideas that we may write more about in the months to come: practical coaching tips; building your solution-focused question library; solution-focused behavior change; and incorporating solution-focused principles in a technology-enabled world. We’d love to hear from you, and learn about what you are interested in learning regarding incorporating a solution-focused approach in  your practice!

    We hope that  2021 will be kind to all of us and that together we can learn how to help people with diabetes live their best 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. 

  • 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

    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

    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

  • Fresh Views

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

    A healthy outside starts from the inside – Robert Urich

    As these crazy and unsettled days wear on, June has silently snuck upon us, bringing with it the first day of summer. Did you know June is also National Fresh Fruits and Vegetables month? We hope you enjoy the picture above of juicy lemons harvested from Deb’s backyard. We are big advocates of finding ways to fit in more fresh fruit (over processed fruit and juice) and fresh vegetables, particularly of the non-starchy variety (which means little impact on blood glucose)! In our experience, many people are challenged with fitting in non-starchy vegetables. And when they’re successful, we’re always curious: How were you able to do that? 

    Today’s word is: EXCEPTIONS

    Today in our series on words to jump-start a solution-focused approach when managing diabetes, we’re focusing on EXCEPTIONS. Exceptions are those times when one’s able to deal with a problem (such as blood glucose out of range, too many carbs) in a way that makes it less burdensome. Exceptions are times when the presenting situation could have happened, but somehow did not.  It’s a time when things could have gone wrong, but didn’t. Most all problems have exceptions. However, some people have difficulty even identifying exceptions because they stay so focused on their problems. Identifying exceptions is essential in order to build future solutions. Exceptions are the tools that help people achieve the life they want. Exceptions are a core tool in solution-focused practice.

    Exceptions are addressed in the book by Adam Brown, Bright Spots and Landmines, which we’ve written about here. There are more than 42 factors that impact blood glucose, and that makes it challenging to stay in range all of the time. Focusing on what is going well, instead of what is wrong, changes the conversation and allows the client to identify strengths and successes, and feel there are those “bright spots” in their life that they can call upon and focus on to know they’ll be successful.

    Here is an example of how you can use exceptions when reviewing continuous glucose monitor (CGM) data

    Meet J.T. She has been experiencing glucose values above range after dinner quite frequently, while the rest of the day has been in-target most of the time. She’s shared CGM graphs similar to the one below, where you can see after dinner at 6pm her glucose rises above target. 

    Today when you meet with J.T. she shares her most recent CGM graph, and you notice that her after meal glucose values are all within her target range. You specifically call this out during your conversation. You might say, “J.T. I notice that your after dinner glucose values are within your target range, how did you manage to do that?”  J.T. tells you that she has been focusing on swapping out starchy vegetables for non-starchy vegetables, like broccoli, squash, tomatoes, and mushrooms, cooking them in a Wok at home with just a small amount of olive oil. She notes that when she eats these non-starchy vegetables she stays in range.  

    This is known as an “exception”, or a time when her typical problem (post-meal above target blood glucose) did not happen. This is when we see “positive differences.” We now want to amplify and intensify these differences. This is the time to focus on the healthy changes being made and time to support and encourage MORE of these choices.

    So you might follow up with, “How was it helpful for you? Or What else was different for you?”

    You might use a scaling question. “ On a scale of 1-10 where 10 is you are confident you could do this again and 1 is the opposite, where would you say you are now?”

    A fave tomato and cucumber salad that Tami enjoys in the summer. She makes it ahead and has it ready in the refrigerator to help her easily fit in more non-starchy veggies at meal time.

    THIS WEEK’S SOLUTION-FOCUSED CHALLENGE

    Each week we’re including a solution-focused challenge that can help evolve care and education in a solution-focused manner. Here’s this week’s challenge: Try incorporating some/all of the following guiding questions into conversations with clients to help elicit exceptions:

    1. Are there times when this has been less of a problem?
    2. What is different about the times when this was less of a problem?
    3. What did you (or others) do that was helpful? 
    4. What’s gone better for you today or over the past week?
    5. What thoughts kept you on track?
    6. At a time when you feel more optimistic and satisfied, what will you be doing more of or more often?

    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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