DAFNE Group management

The DAFNE Group management unit is part of the DAFNE face-to-face conversion training for DAFNE educators who have completed their Remote DAFNE educator programme, delivered at least one Remote DAFNE course, and wish to deliver face-to-face DAFNE course formats.

The DAFNE group management unit focuses on the differences between remote and face-to-face group facilitation, and classroom-based teaching techniques.

Supporting resources

To complete this unit you will need to draw on your own experience of facilitating groups (either Remote DAFNE, or other remote or face-to-face groups) and refer to:

• The DAFNE curriculum, including lesson plans
• DAFNE course book
• DAFNE activities book
• Your DAFNE centre resources (DAFNE flip chart, insulin posters, replica food models, food plate pictures).
• Other resources required (food labels, real cooked and dried foods, recipes, carb counting resources, hypo treatments, insulin pens, Glucose and ketone checking equipment, glucagon injection)

People approach learning in different ways. There are a number of factors that, when combined, help to create a positive learning experience for you and your course participants.

These factors can be explained using Maslow’s ‘Hierarchy of Needs’ (Bates, 2016). This highlights that people have within them two sets of needs: one that strives for growth and one that clings to safety. In general, if a person must choose between these two needs, they will choose safety. So, unless people feel safe, they are unlikely to explore anything new.

Maslow’s Hierarchy of Needs is divided into two phases:

Lower order needs

• Physiological: comfort, heating and lighting.
• Safety: physical and psychological.

Higher order needs

• Belonging: acceptance and mutual trust.
• Esteem: self-confidence and self-respect.
• Self-actualisation: realising potential and a desire to grow.

A positive learning environment means that a participant feels comfortable, has a sense of rapport with you as the group facilitator and with other group members, and believes they can be successful. An environment where participants do not feel physically comfortable, accepted and respected is a distraction from learning.

A positive learning environment contributes to a positive learning experience.

Environmental factors

Adults learn best when they feel safe and comfortable in their environment and know what to expect. An environment conducive to effective learning will have taken into account physical as well as social and emotional factors.

In other words, the educator will have considered things like appropriate seating, lighting, heat, etc., and considered their own attitudes and behaviour and those of the course participants and how these can impact on the learning environment.

You have not had to consider some of these factors when facilitating Remote DAFNE because you and your group have not occupied the same space, the same physical environment. Let’s think about the physical environment in more detail.

Many aspects of the physical environment can affect how safe and comfortable we feel in a face-to-face group situation.

The following activity asks you to think about your venue and identify what aspects of the physical environment can make people feel safe and comfortable. Consider what would make an ideal venue that did not present barriers to attending face-to-face DAFNE course.

Activity 1: Venue

What can you do to create a physical environment that feels safe and comfortable for participants on your own face-to-face DAFNE course? Begin by considering your venue.

Make some notes against each heading before looking at our suggestions.

Venue location

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The venue

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Venue facilities

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Catering

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Listed below are some of the things you need to consider when choosing an appropriate venue in which to hold a face-to-face DAFNE course and when planning for course delivery. Discuss these factors with your team when you consider appropriate venues.

Venue location

• Will your venue be on a hospital or community site?
• Will there be a financial cost for using your venue, if so how much and how will you budget for this?
• Is the venue easy to get to for you and participants in your catchment area, how far will people need to travel?
• Are there public transport links to your venue, do they operate at appropriate times for people to arrive and leave on time, do they accommodate people with disabilities?
• Is parking available?
• Is parking free or is there a charge? Can you negotiate a reduced charge or free parking?
• Consider lone working requirements. Is the venue safe after dark?
• How and when will you transport equipment and resources to your venue?

The venue

• Is the venue appropriate for your DAFNE course?
• Is it available for the duration of your course, Monday to Friday or one day a week for 5 weeks?
• How will you access the venue, who will be responsible for accessing and closing the venue, is a member of staff available or will you be a key holder?
• Is it open long enough for you to be able to set up and pack away your resources?
• Are you allowed to attach posters to the walls, if so how (sticky tack / magnetic boards)?
• Are you allowed to store your resources and equipment at the venue overnight?

Venue facilities

• What facilities does the venue offer? For example:

  • Disabled access / lift / hearing loop
  • Sufficient number of toilets / disabled access toilets / hand washing facilities
  • Safe storage space for resources / sharps bins / hypo treatments
  • Private spaces if required, for example for prayer
  • Projector and screen / smart board
  • Extension cables for laptop / visualiser / projector
  • Whiteboard or flipchart and paper, pens

Catering

• What catering options are available?
• What will you eat and drink, and where?
• Does the venue offer lunch and refreshments for breaks, if so, what is the cost?
• Will participants bring their own lunches?
• Will you provide a kettle / cups / teas / coffee / milk / sweeteners / sugar / squashes?
• Will you be able to offer culturally appropriate refreshments?

Now you have considered your venue, let’s think about some other specific factors that relate to face-to-face DAFNE courses.

Activity 2: Classroom

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Play the video clip here for factors to consider about your classroom layout and use. Discuss these factors with your team.

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Slide 1 narration:

Ideally, your classroom should be a medium to large room with natural light, ventilation and heating or air conditioning, a central table and seating, and additional tables in the room for practical breakout activities required in some DAFNE sessions. You also need a screen or wall area for projection of shared DAFNE diaries or CGM downloads for group discussion using a laptop, visualiser and projector. You need a wall area to display the DAFNE flip chart and insulin action posters, or a smart board to show these electronically. Remember to check with your venue if you can use blu tak on the walls or if alternative arrangements are in place for affixing posters to the walls. You will also need a flip chart stand, flip chart paper and pens, and you may need two of these set up if you have limited wall space. The classroom should have enough space to accommodate eight participants, two educators and any support people who wish to accompany participants for appropriate sessions, for example, severe hypos and illness management. Also consider if colleagues may be observing part of a course. If so, you will need space to accommodate a maximum of two observers as well. Also consider the location of the room within the building – is it quiet and private, or will you be disturbed by other venue users?

Slide 2 narration:

There are a number of ways that you can use the DAFNE flip charts, depending on your local resources and your personal preferences. For example, in this setup, you need space at the front of the classroom to display the DAFNE flip charts used during your session. By doing so, you will be able to highlight significant learning points and remind the participants of key DAFNE principles throughout the session. When the session has finished, you can move the flip charts to another part of the room where they will still be easily visible. An advantage of using the hard copy resources in this way is that you can refer to these flip charts quickly at appropriate times throughout the course. Then, as the DAFNE course progresses, more flip charts will be put up around the room demonstrating how the participants’ learning is building session by session. The printed DAFNE flipcharts may be appropriate if you do not have access to digital technology.

Slide 3 narration:

It is not helpful for participants to display all the DAFNE flip chart pages and insulin action posters on the walls all the time, from the beginning of the course. Participants need to be able to focus on the appropriate information at the right time rather than being overloaded by information and unclear about where to find it from the start. However, by putting flip charts up on the walls, as and when they've been used during your sessions, the participants will see how their knowledge is building and will be familiar about where to find information during discussions.

Slide 4 narration:

You may prefer to display the electronic DAFNE flip chart pages using a smart board or projector. Think about your access to IT in your venue and your own IT skills. Can you display more than one flip chart page at a time and find the appropriate page to display quickly? The resources section of the curriculum for each session outlines which DAFNE flip chart pages or insulin action posters you need to refer to. The electronic DAFNE flip chart pages and insulin action posters may be appropriate if you have limited wall space or are not able to use the walls for display purposes.

Slide 5 narration:

Participant interaction is an integral part of the DAFNE course and your classroom should enable small group and pair work so a lecture hall layout with seating in rows is inappropriate for this reason. Participants spend a whole day in the classroom. They need to complete activities in the activities book and refer to other resources throughout the course, so seating without appropriate table space is also not appropriate.

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Activity 3: Resources

Resources

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Play the video clip below to find out more about the resources you will need to deliver a face-to-face DAFNE course format and how to order DAFNE specific resources.

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Slide 1 narration:

The slides that follow outline the resources required for DAFNE course delivery. As part of planning your DAFNE courses, you may also need to consider if any of the course participants require large print versions of resources. Do any course participants require an interpreter? Make sure all your resources have been ordered and delivered before your course dates.

Slide 2 narration:

There are DAFNE specific resources that are essential to deliver face-to-face DAFNE course formats. Make sure that you have ordered and received your DAFNE resources and that you are familiar with them before planning for course delivery. In addition to DAFNE resources, you will also need some resources that are provided locally. The course resources checklist, shown here, details all the resources required for course delivery and can be found in the central resources area of the OpenLearn Create platform, shown here. Please remember the central resources area is updated from time to time, so the location of documents may change.

Slide 3 narration:

The DAFNE flip chart set is an essential resource for DAFNE course delivery and contains key information and images illustrating the DAFNE principles for insulin dose adjustment and carbohydrate counting. The resources section for each DAFNE session in the curriculum outlines which flip charts are used in each of those sessions.

Slide 4 narration:

These four flip charts are used to explore and describe how insulin works in the body and what happens in type 1 diabetes when insulin production stops. They’re used primarily in the session ‘what is diabetes?’ but may also be referred to in the sessions ‘insulin injection technique’, ‘insulin regimen’, ‘Glucose checking and targets’ and ‘illness management and sick day rules’. The lesson plans for each session contain references to appropriate DAFNE flip charts that may be used to support the participants’ learning.

Slide 5 narration:

These two flip charts are used primarily in the sessions on mild and severe hypoglycaemia. The flip chart ‘managing hypos and hypo alerts’ is referred to throughout the course to remind participants of the hypo treatment guidance in DAFNE, as this may be different from their usual hypo treatment. Hypo treatment guidance is first referred to in the 'introduction to DAFNE' session and reiterated in the session 'introduction to carbohydrate counting'. It’s also helpful to display the flip chart during the group discussions of DAFNE diaries or CGM downloads, to inform discussion of appropriate actions to take to manage a hypo or hypo alert. The flip chart ‘causes of hypoglycaemia’ may also be referred to in the sessions on managing alcohol and physical activity and exercise, because it’s not uncommon for these lifestyle factors to be associated with hypoglycaemia if insulin adjustments are not made.

Slide 6 narration:

Counting carbohydrate in 10 gram portions is a key DAFNE principle and this flip chart is first referred to in the 'introduction to carbohydrate counting' and 'counting CPs' sessions. It’s also a useful reference during group discussions of CP counting at lunchtime, as well as during the 'insulin dose adjustment' and 'action planning' sessions when it acts as a reminder of the importance of accurate CP counting.

Slide 7 narration:

These flip charts are used in the session ‘Glucose checking and target ranges’ to illustrate accurate blood and sensor glucose checks, DAFNE Glucose targets and how achieving Glucose targets can contribute to optimal Glucose management in the longer term. The ‘DAFNE Glucose target ranges’ flip chart is also referred to in the sessions on the ‘stepwise approach’, ‘insulin dose adjustment’, ‘corrections’ and ‘increasing or decreasing an insulin dose’. Appropriate dose adjustment is based on accurate Glucose checks and CP counting. Without accurate Glucose checks, participants will be unable to take the appropriate amount of insulin. Participants need to be clear about their glucose targets so they can take steps to return out-of-target Glucose back to target when necessary. Participants are encouraged to aim for DAFNE targets pre-meal and pre-bed, or if these targets are not appropriate for them, to set personal glucose targets initially, then work towards DAFNE Glucose targets over time. Achieving DAFNE targets as often as possible can help participants achieve their longer term HbA1c or time-in-range targets, which may relate to their daily action plans as they work through the course and ultimately to their long-term diabetes goal. The DAFNE Glucose targets are often referred to in the lunchtime CP counting discussions and the group discussions of DAFNE diaries or CGM downloads.

Slide 8 narration:

These flip charts are used in the DAFNE sessions on the DAFNE insulin regimen, correcting out-of-target glucose, increasing or decreasing an insulin dose and the stepwise approach. Participants need to consider the onset, peak and duration of the insulin they are using in order to identify which insulin is acting and to inform appropriate insulin dose adjustments. These flip charts are used in conjunction with the DAFNE insulin action posters to demonstrate the action profiles of different insulins.

Slide 9 narration:

The stepwise approach is the cornerstone of insulin dose adjustment in DAFNE and it outlines the steps to follow to implement safe and appropriate insulin dose adjustment. The stepwise approach flip chart is used in the sessions on increasing and decreasing an insulin dose, alongside activities in the activities book and it’s key to the DAFNE diary and CGM download discussions at the beginning and end of each day.

Slide 10 narration:

Managing physical activity and exercise can be one of the most challenging parts of daily Glucose management. It’s important that participants are aware of the effects of different types of exercise on their Glucose in order to determine the most appropriate way of managing that effect. The physical activity and exercise flip chart is used primarily in the session ‘managing activity and exercise’ but it's also a useful reference when considering other causes of out-of-target Glucose during group discussions of DAFNE diaries or CGM downloads at the beginning and end of each day.

Slide 11 narration:

These flip chart pages are used in the long-term health and diabetes session. They provide a framework for group discussion about the long-term complications of diabetes, the importance of accessing healthcare checks, as well as the value of working with their diabetes team to promote and maintain their health in the long term. The annual review game is also used in this session and reflects the flip chart content. The group discussion about long-term health and diabetes often generates questions for the doctor, so you may find it helpful to ‘bank’ or ‘park’ questions in the usual way during this session. Participants may find it helpful to have the results of their last annual review checks to hand during this session.

Slide 12 narration:

The DAFNE insulin posters illustrate the following. Number 1 shows insulin production in a person without diabetes. Number 2 shows once-daily BI analogue and QA analogue with meals. Please note that this poster and the examples in the course book are not based on an ultra-long acting once daily BI. Number 3 illustrates the DAFNE insulin regimen based on twice-daily BI and QA analogue with meals. The posters are used to illustrate the insulin coverage given by the DAFNE regimen and how this mirrors insulin production in a person without type 1 diabetes. As you know from your clinical experience and experience with Remote DAFNE, those using once-daily BI may notice their Glucose rises at times when once-daily BI may wane; this is illustrated in the dose adjustment activities and may promote discussion on self-management strategies or changes to an individual's insulin regimen.

Slide 13 narration:

The DAFNE food plates are used in the session ‘Counting CPs’ to compare visual estimation with actual CP counts. They can also be a useful resource in the session ‘eating out’ when participants are discussing how to manage their Glucose when eating away from home; the food plates may be used to create fictional restaurant meals of one, two or three courses, which participants can choose and discuss.

Slide 14 narration:

The replica food models are used in the introduction to carbohydrate counting session as part of an activity to identify which foods contain carbohydrate, which do not and foods the group is unsure about. They’re also used in an activity to divide carbohydrate containing foods into those that require QA, those for hypo treatments and those that may digest too slowly to need to be matched with QA. They are also used in the session ‘counting CPs’ to compare visual estimation with actual CP values from the Carb portion list. They can also be a useful resource in the eating out session; they may be used to create fictional plated restaurant meals which participants can choose and discuss.

Slide 15 narration:

Each course participant requires a participant pack to include the items shown here. The course book which contains all the content referred to during the course. The activities book which includes examples and activities to complete as part of DAFNE sessions. The DAFNE diary which is a paper diary that some participants may wish to use during their course, or they may prefer to use their CGM downloads if you have the IT equipment at your venue to share this information. Remember, downloads should include CPs, QA and BI doses, and comments about lifestyle factors as well as Glucose checks. The Carb portion list is also included in the participant pack, and this is used as the main carb counting reference during the course. Order the course book, activities book, DAFNE diary and Carb portion list from central DAFNE. The blank A4 diary sheet can be used to transfer information from the DAFNE diary to share using the visualiser. This can give a clearer image than sharing the diary directly and allows participants to transfer only relevant information. The GP letter allows participants to note any prescription changes they would like at the end of the course, for example, the inclusion of a Glucagen kit and ketone check strips. Both the blank diary sheet and the GP letter can be downloaded and printed from the central resources area. The blank diary sheet is under the tab ‘resources for face-to-face delivery’. The GP letter is under the tab 'Recruiting & planning and delivering a DAFNE course'. You will need to provide each participant with a name badge, pen or pencil and labels for their personal equipment to avoid mix ups and possible needle stick incidents from people using someone else’s lancing device or pen.

Slide 16 narration:

There is a tab in the central resources area that provides information on how and when to order your resources. If you work in a new centre or a centre that has not yet delivered any face-to-face courses, give yourselves plenty of time to order your resources. Remember to order your replica food models three months before your first course! As DAFNE resources are updated, the order form will also be updated, so always download a new form from the central resources area when you place an order!

Slide 17 narration:

In order to deliver your DAFNE course, you will also need the locally provided resources in the checklist. Have you made sure that DAFNE resources are available for your course dates (i.e. the DAFNE flip chart, insulin action posters, food models, food plates / pictures)? Have you got enough participant resources (course books, activities books, Carb portion lists, DAFNE diaries and evaluation sheets)? Have you planned for safe sharps disposal with a sharps bin and some cotton wool? Have you got spare meters, pens and needles available at your venue, in case a participant forgets their own, and for demonstrations in the insulin session? Have you arranged for fresh, cooked and dried real foods and examples of food labels to be available for the session ‘counting CPs in everyday foods and from food labels’?

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Activity 4: Time

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Play the video link here for information on the timings of sessions, breaks and lunchtime on a face-to-face DAFNE course.

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The DAFNE course timetable for participants outlines the following things. The start and finish time each day, the content covered each day, and break times and lunch times, including the option to delay lunch on one day in order to carry out a daytime BI check. You’ll see that timings for each session are not included in the participant timetable. This is because timings may need to be flexible to suit the needs of the group. However, it is important that the course finishes on time.

Slide 2 narration:

The 5x1 DAFNE course timetable, shown here, follows a similar format to Remote DAFNE, in that each week follows a theme such as ‘getting the basics right’, ‘insulin and insulin dose adjustment', 'below target Glucose', 'Above target Glucose' and 'Long term health and diabetes'. It also includes the option to delay lunch on one day, in order to carry out a daytime BI check. It can be helpful to provide a course timetable as part of the pre-course appointment, to clarify the time commitment for the course and highlight sessions when it can be helpful for a participant to have a support person attend with them, for example, the severe hypos, when you need help session, and sick day rules session. A support person is welcome to attend other sessions but the content of these particular sessions include when a participant may need help from someone else.

Slide 3 narration:

The DAFNE and 5x1 DAFNE timetables for the educator are in Sections 2.1 and 2.2 of the DAFNE curriculum. The timetable is provided for each day and includes the start and finish times, as per the participant timetable, session titles, as in the participant timetable, as well as the lesson plan required for each session, including the section number in the curriculum. The timetable also includes the timing of the session. The timing of the session is also outlined in the lesson plan. Part of the educator role is to keep control of the pace of learning. Allow plenty of time for discussion and appropriate activities, and don’t forget to provide resources to meet the participants’ learning needs. Use the group agreement appropriately to keep on track, including the importance of punctuality for both you and the course participants. Before you deliver a course, make sure you have a thorough knowledge of the timetable and the content of the lesson plans for your sessions; this will help you manage the group and keep to time.

Slide 4 narration:

Time for morning and afternoon breaks is included in the timetables. Break times are important to allow the group the opportunity to reflect, interact, share experiences and have a break from learning. So, don’t cut into the break times.

Slide 5 narration:

Having lunch as a group on each day of the course is an essential learning opportunity. CP counting and insulin dose adjustment at lunch time allows participants the opportunity to practise their CP counting with guidance from both the educators and to learn from the CP counting of other group members. Lunch time CP counting is also an opportunity to weigh carb-based food and count CPs accurately so that both educators and participants are confident in lunch time CP counting. This helps in diary or CGM reviews when considering if an insulin dose needs to be adjusted. Participants will learn about a broader range of foods containing carbohydrates by sharing this CP counting experience with the rest of the group, than if they only count their own CPs each day. Participants also need time alone as a group without educators present to share their thoughts about the course and gel as a group. The pre-course appointment is an opportunity to highlight that lunch time CP counting is part of the course but they will have a 30-minute lunch break after the CP counting session. On the DAFNE course, Wednesday includes the option to delay lunch to check their daytime BI whereas on 5x1 DAFNE, this opportunity occurs in Week 3.

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As with the physical environment, many aspects of the social and emotional environment can also affect how safe and comfortable we feel. The next activity asks you to think about these when planning your own DAFNE course.

Social learning is about support and building self-esteem and confidence. For this to happen, we must focus on creating the appropriate environment.

One of the most important sessions of your DAFNE course is the first session: introduction and organisation. This session allows you to set the climate for the course. In this session your group first get to know the venue, you and your co-educator, each other and what the course holds for them. The introductory session allows the group and the educator to:

• take the first step in establishing an environment conducive to effective learning
• begin to understand participants’ motivations, orientation and readiness to learn.

View the introduction to the DAFNE course for tips on making the most of your introductory session below.

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Participant experience on first entering the room and meeting educators and other members of the group can set participant expectations for the course. For this reason, it’s important to create a positive experience by being welcoming, friendly and putting participants at ease, encouraging interaction between group members as soon as possible.

Slide 2 narration:

At the pre-course appointment, or soon after, make sure you give participants clear instructions about the venue and the room being used for the DAFNE course. Not being sure which room to enter or being faced with a closed door may increase participant anxiety and create a barrier to engagement. Signposting your room clearly and keeping your door open shows participants they are welcome.

Slide 3 narration:

Make sure you arrive at your venue in plenty of time to set up the room for the day before your participants arrive. Make sure you’re prepared for your session so that you have time to welcome group members as they arrive and point them in the direction of refreshments. Make conversation with your participants so you can further put them at ease and so you’re aware of their journey to the course and how they’re feeling. Introduce group members to each other and highlight common experiences if you can so they can chat with each other. Provide a selection of hot and cold drinks that will be available at the beginning of the day and at break times, and reassure participants that they can help themselves to drinks at any time.

Slide 4 narration:

Participants need to get to know each other so include an ice breaker that you feel comfortable using, such as people bingo or pick a card and talk about why you picked it – ideas for ice breakers are included in the lesson plan and you can find many ice breakers online. Set the scene for working in pairs and small groups by explaining that you’ll be using different methods of pairing up participants or dividing them into groups – you might use a deck of playing cards and group all the Kings together in one group and all the Queens as another group, or you might divide the group into four pairs by giving them each a name and asking them to find their partner e.g. Starsky and Hutch, Posh and Becks or Ant and Dec; alternatively, you might allocate either the number one or the number two to each participant and group all the number ones together and all the number twos together. Whichever method you use, you can plan ahead to ensure that different people work together throughout the course or you can make the allocation to a group or pair completely random.

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As you are aware from your experience of Remote DAFNE facilitation, groups function best when both participants and facilitator clearly communicate their expectations of each other. A key tool for establishing a safe and comfortable environment, and to help the group to manage themselves, is a group agreement or set of ‘ground rules’. This agreement should be created collectively at the very beginning of the course and referred to (by the educator or group members) throughout the course, as required.

The group agreement should outline how the group as a whole agrees to behave and should encourage positive behaviours. You may suggest items for the agreement that will help you to facilitate learning and manage the group, but don’t impose them.

Write the group agreement on the flipchart paper (or alternative). Keep a copy of the group agreement where everyone can see it and refer to it as needed. Add to the list if you need to during the course. If anyone infringes the agreement, you could remind them that it is their agreement they are breaking.

Attitudes and beliefs influence how participants behave in a group and how we behave as DAFNE educators. No matter what the purpose of the group is, people bring their whole person to the group.

Although individuals attend DAFNE to learn how to self-manage their diabetes, they also have an entire ‘other’ life going on including family, work, financial and other health issues. These issues cannot be separated from their diabetes management. We need to appreciate this so that we do not discount the factors that impact on individuals’ self-management.

Equally, we as healthcare professionals bring our whole person to the group. Most of us have invested a significant amount of time and effort, working hard to develop the expertise and knowledge necessary for our roles. In our day-to-day clinical interactions with people with type 1 diabetes we are usually trying to meet some of our own needs as well as theirs.

As healthcare professionals working in diabetes, we need to feel effective, and may view the diabetes management skills of the people with type 1 diabetes that we interact with clinically as a measure of our effectiveness. Sometimes we may feel that we ‘know best’ and are ‘responsible’ for a person’s self-management choices. In reality we have no control over those choices. Feeling responsible for what we cannot control can lead to feeling discouraged, frustrated and ineffective.

By considering the attitudes and beliefs of course participants and understanding our own attitudes and beliefs we will be more effective as DAFNE educators.

Most participants attend a course because they want to, and engage enthusiastically in the group. People’s behaviours often reflect their previous experiences and how they feel about the situation they are in. Occasionally change can be challenging and can provoke resistant or unexpected behaviour.

We all have expectations, which often include wanting to be heard, acknowledged and respected as individuals. Participants respond to an environment in which they are valued and have a voice. Each course is different because the participants are different. This diversity can enrich the learning environment.

View the Participants slides in the interactive activity below.

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Slide 1 narration:

Most participants attend a DAFNE course because they want to, and they engage enthusiastically in the group. People’s behaviours often reflect their previous experiences and how they feel about the situation they are in. Occasionally change can be challenging and can provoke resistant or unexpected behaviour. We all have expectations, which often include wanting to be heard, acknowledged and respected as individuals. Participants respond to an environment in which they are valued and have a voice. Each course is different because the participants are different and this diversity enriches the learning environment.

End transcript

 

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Facilitation is about how you teach rather than what you teach. It’s about making the process of learning easier for people. The more barriers to learning you can address before the course begins, the easier the process will be. You have experience from facilitating Remote DAFNE courses of educator behaviours that help to facilitate learning. As a reminder, the core of effective facilitation is to:

• be true to yourself; always be genuine and honest with course participants and try to establish rapport
• be willing to consider issues from the other person’s standpoint, and try to understand how participants feel about the course
• accept participants for what they are in a non-critical and non-judgemental way
• respect participants’ experience and think positively about their ability.

As healthcare practitioners, we work within equality and diversity policies and intentional discrimination of any kind is not acceptable. It is important to be aware of any potentially discriminatory attitudes and behaviours you may bring to your courses. These behaviours may be based on assumptions, lack of understanding or habit.

Some things that can help you to avoid discrimination and to value all participants equally are:

• Assume that participants have a diverse range of backgrounds and experiences. You may not know them before the course, so try to get to know them during the course.
• Don’t avoid discussing an issue because it may feel uncomfortable. Ask the group’s permission, either when you introduce the topic or if the issue arises in some other way. Explain why the issue is relevant and why it is important to discuss it.
• Treat all participants equally – take into consideration their past experiences and individualities. Be aware that some experiences can trigger strong emotions. Don’t assume no one has had such an experience.
• Don’t single out participants and expect them to represent a group view. If you are aware of a participant’s experience (e.g. severe hypo or diabetic ketoacidosis) don’t assume they are happy for you to share that experience with the group. Allow people to choose what they share.
• Be sensitive to the needs of participants with disabilities, cultural or medical requirements without singling them out. Use your pre-course appointment to pre-empt and highlight any particular needs.

The social and emotional environment means creating a safe space for learning where all participants are valued and treated equally. Your role as the educator is important in setting the tone by modelling behaviours that will ensure the environment is one of trust and openness.

As a DAFNE educator, the skills you develop are key to making the DAFNE course work.

This section will explore:

• some of the barriers to effective face-to-face course delivery
• the resources available to you to ensure effective course delivery
• some key teaching techniques and facilitation skills
• tips for delivering classroom-based activities that will help you facilitate face-to-face DAFNE courses.

Some of the information in this section is a reminder of techniques and skills you have already used as a Remote DAFNE educator. You may also be aware of some of the barriers to effective face-to-face course delivery, and have your own tips for delivering classroom-based activities if you have delivered face-to-face group education previously. If so, sharing your experience during the workshop will be valuable to the group. Make a note of your tips for delivering classroom-based activities in your training handbook.

You may be familiar with the concept of health literacy if you have completed the Carbohydrate counting unit recently, as part of the Remote DAFNE educator programme. If you have not completed the Carbohydrate counting unit recently this section will give you an overview of health literacy.

Literacy is defined as ‘the ability to understand and respond appropriately to written texts’.

Numeracy is defined as ‘the ability to use numerical and mathematical concepts’.

The term ‘health literacy’ is used to encompass both literacy and numeracy issues in a healthcare situation and is considered more complex than ‘literacy’ alone.

Those who do not usually struggle with literacy and numeracy may face health literacy challenges. Health literacy can affect us all, particularly if we are overwhelmed by anxiety or worry; for example, coming to terms with the diagnosis of type 1 diabetes, developing a complication of diabetes or the worry of everyday diabetes management.

Health literacy is about people having enough knowledge, understanding, skills and confidence to use health information, to be active partners in their care, and to navigate health and social care systems. Health literacy is being increasingly recognised as a significant public health concern around the world.

Evidence suggests that health literacy interventions at both system and practitioner level can impact positively upon health behaviours and health outcomes in those with low health literacy.

DAFNE participant resources are regularly reviewed and updated, working towards presenting information in a way that supports health literacy.

It is important that your approach to session delivery also supports health literacy. The methods used to teach a group of medical students or other healthcare professionals are unlikely to be appropriate for DAFNE course delivery.

All four nations in the UK have identified improving health literacy as a priority.

Adults are considered to be ‘functional’ in literacy (i.e. they can function in everyday life) if their level of literacy is at Level 1 (GCSE grade D–F) and above. The majority of adults in England are in the 11–14 years old reading age group. This means that in a health setting they will be able to:

• understand the words on more complex posters and simply worded leaflets
• understand a short formal letter, note or form, and a telephone call to 111
• describe in more detail the degree and type of pain and understand what they have been prescribed by a clinician.

In the different countries that make up the UK, around half of the adult population (18–65) do not have adequate literacy skills to understand routine health information. This means that four out of a group of eight DAFNE participants are likely to find reading written information challenging.

Adults are considered to be ‘functional’ in numeracy (i.e. they can function in everyday life) if they are at Entry Level 3 (typical of an 11 year old) and above.

Almost a quarter of the UK adult population is below this level. The majority of adults in England have the numeracy capabilities of a 9 year old.

This means that in a health setting they will be able to:

• understand appointment times using the 12-hour clock; e.g. 9:15 but not 14:15
• measure weight, height and temperature using straightforward scales and metric measures
• understand simple instructions about medication, timings and dosages; e.g. take 5 ml three times a day after food.

This means that two out of a group of eight DAFNE course participants are likely to find the maths skills involved in DAFNE challenging.

The problem of poor health literacy affects a significant proportion of the population. Taking that into account, organisations that deliver health services or provide health information to people need to ensure that the information they provide, and the way it is communicated, is at an appropriate level for the majority of the population to understand.

If you would like to read more evidence about health literacy, there are some additional references at the end of the unit.

Those of us with lower levels of health literacy:

As we have seen in the health literacy section, it is likely that two to four participants on a DAFNE course will find some aspect of literacy and numeracy challenging. 

When you are facilitating a DAFNE course, it is important to think about literacy and numeracy skills. DAFNE involves some complex concepts, so we need to ensure we fulfil our philosophy aim to provide optimal therapeutic patient educational care so that choices are fully informed.

Healthcare professionals often underestimate health literacy needs. This is because these needs often remain hidden and some of us actively hide them. This may be because we are too ashamed, or too polite to reveal to others that we have not understood them. While this is particularly common in those who have difficulty reading, writing or using numbers, it can affect all of us – particularly if we are overwhelmed by anxiety or worry.

As DAFNE educators we also need to consider our own literacy and numeracy skills. Around one in ten of all university students in England have numeracy or literacy levels below Level 2 (GCSE A*–C), so it is likely that some educators may find teaching DAFNE numeracy skills challenging. Being familiar with the DAFNE course curriculum, course book and activities book, can help to overcome these difficulties.

Clear communication between you and the participants in your DAFNE group is essential. There are a number of teaching techniques that can help you to facilitate health literacy.

These techniques are discussed in the section ‘Teaching techniques’.

The principal aim of the DAFNE programme is to facilitate autonomy, competency and confidence in the self-management of diabetes by providing skills-based training in the areas of carbohydrate counting and insulin dose adjustment in a comprehensive range of situations.

As in Remote DAFNE, the flow of the course outlined in the timetable is designed to support health literacy by introducing simple concepts first, then building on them.

As an educator, you need to be familiar with the three key resources you will use to deliver a DAFNE course.

• Curriculum
• Course book
• Activities book.

The following sections explain these three resources in detail.

The curriculum details all the key components that must be included in every DAFNE course. This is the measurable content of each course. Refer to your own copy of the curriculum during this section.

The curriculum can be used for delivery of both DAFNE and 5x1 DAFNE courses.

You will view a presentation about the differences and similarities between 5x1 DAFNE and other DAFNE course formats as part of the next training step.

The DAFNE curriculum includes everything you need to cover and acts as a guide as to how you might deliver it, and helps to ensure that your teaching is effective, timely and logical.

It is your role as an educator to ensure that participants have the opportunity to achieve the learning outcomes for each session included in the course by making sure that session content is covered.

This is the measurable content of each course.

The course book contains all the content of the DAFNE course. The course book is referenced in the lesson plans and referred to throughout the course to illustrate DAFNE principles. Participants can use the course book as a reference after the course.

The activities book contains activities to complete during the course to practise key DAFNE skills and is referenced in the lesson plans in the curriculum.

Refer to your own copy of the curriculum, course book and activities book during this section.

Watch the video that follows and make notes in your training handbook of any questions or points for discussion to take to the workshop.

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Slide 1 narration:

The DAFNE curriculum can be used to deliver DAFNE and 5x1 DAFNE courses. It will be helpful to have your curriculum to hand for this next stage of your training. The curriculum is organised into nine sections. We’ll now look at each section in detail.

Slide 2 narration:

Section 1 of the curriculum is the pre-course appointment. The pre-course appointment information is very similar to Remote DAFNE, so explore each participant’s expectations and answer their queries or concerns. Recap what is involved in a DAFNE / 5x1 DAFNE course and provide information about the course and discuss any barriers to course participation. Ensure participants are clear about, and are able to commit to, the time required for their DAFNE / 5x1 DAFNE course. Collect their baseline data. Discuss and agree any changes to their insulin regimen in line with the DAFNE starting regimen shown here. Section 1.8 is the starting regimen you are familiar with, and note the different stages in the course at which the participants will change to the DAFNE insulin regimen; the time they change depends on the type of DAFNE course they attend. Participants on a DAFNE course make insulin changes the night before or the morning of day 1. Participants on a 5x1 DAFNE course make insulin changes the night before or the morning of Week 2. An exception might be if a basal insulin change is agreed prior to the course in which case you may wish to arrange a prescription change before the course begins. This can be especially helpful if there may be delays in filling the prescription which would delay the participant access to the new insulin. If the pre-course appointment is face to face, consider asking your participants to bring their Glucose and ketone checking equipment and their insulin pens to the appointment so that you can replace faulty equipment if needed. Section 1.9 relates to the lunch time CP counting session; it’s so important to set the participant’s expectations of this during the pre-course appointment. Explain to your participants that the purpose of this session is to explore the CP content of many different types of foods so the participant is able to build up their knowledge of a wide range of foods for the future. They're also able to check the accuracy of their CP counting in a safe and supportive environment. Section 1.10 is about the participant pack. Your participants will need the pack to be able to take part in a DAFNE / 5x1 DAFNE course. Make arrangements for these resources to be available at your venue on the first day of the course. Section 1.11 is about the DAFNE team pre-course review; it’s recommended that the educators involved in the course meet with the DAFNE doctor to review the course participants’ medical notes and information recorded at the pre-course appointment. This meeting can provide clinical support for insulin adjustment decisions and an opportunity to highlight targets / areas of concern.

Slide 3 narration:

We’ve looked at Section 1 about the pre-course appointment, so let’s now look at Section 2 – How to use this curriculum. Then we’ll look at the remaining sections in more detail. Section 2.1 shows the daily timetables for the DAFNE course which are laid out the same way as this example. Section 2.2 shows the weekly timetables for the 5x1 DAFNE course.

Slide 4 narration:

Section 3 is the largest section of the curriculum and is used directly for course delivery. Each lesson plan includes its title and the flow and timing of the session. It also shows the purpose of the session, and participants’ learning outcomes (as you know from Remote DAFNE, the learning outcomes are what the participants should get from the session). Following on from the learning outcomes is the list of resources required for session delivery, and then you have lesson plan. This includes all the details of any classroom based activities, as well as the resources and expected time required for each section of the lesson plan. A new feature is the ‘Content Checklist’ at the end of the lesson plan – when you have finished delivering your session, this acts as a quick reference guide so you can check you have delivered all the essential and expected content, as well as any appropriate optional content. Remember, essential and expected content should always be delivered in a session; optional content is delivered when it is appropriate to group members. All content is included in the lesson plan.

Slide 5 narration:

Section 4 contains one lesson plan which is specific to the DAFNE course and is NOT used in 5x1 DAFNE. The lesson plan is for the session ‘Glucose checking and target ranges’ and is delivered on the Monday of the course, or the first day of the DAFNE course. It follows the same format as all the lesson plans in Section 3.

Slide 6 narration:

There are four lesson plans specific to 5x1 DAFNE delivery and you will find these in Section 5 of your curriculum. In the 5x1 DAFNE course, glucose checking and target ranges is split across three weeks so there are three lesson plans. Section 5.1 is ‘5x1 DAFNE Glucose 1: Glucose and ketone checking’. Section 5.2 is 'Glucose 2: DAFNE Glucose target ranges and the DAFNE diary’. Section 5.3 is ‘Glucose 3: HbA1c, time in range and the reasons for optimal Glucose management'. There is a session at the end of each week which is unique to 5x1 DAFNE and you’ll find this is Section 5.4, which is ‘Taster for next week, summary, goal and action plans'.

Slide 7 narration:

Sections 6 – 9 contain supporting information that you are already familiar with because it’s also included in the Remote DAFNE educator manual, namely, abbreviations and symbols in Section 6, the DAFNE philosophy in Section 7, and an overview of the educational theories underpinning DAFNE in Section 8. Section 9 is the Oz DAFNE Facilitator Numeracy supplement. This final section is particularly relevant to face-to-face delivery as there may be more opportunity to support participants with numeracy through classroom based activities.

Slide 8 narration:

Make sure you are familiar with the content of the course book and when content from the course book is referred to in the lesson plans before delivering your DAFNE course. Sections are colour coded and the colour matches the related sections in the activities book. The lesson plans include references to section titles in the course book so use the contents list to find the relevant page. Useful figures in the course book are referred to in the lesson plans as well. Use the list of figures to find the relevant one. Useful tables in the course book are referred to in the lesson plans, so again, use the list of tables to find the relevant one you're looking for. It may be helpful to mark content, figures and tables in the course book with page markers so you can find them easily.

Slide 9 narration:

The activities book includes examples, activities and personal notes for participants to complete as part of their DAFNE course. A key is given at the beginning of the activities book to denote examples, activities and notes, and those keys are shown here. This slide shows how a combination of a personal note and an activity can support a participant’s learning about hypo treatment. This page demonstrates an example of how to record snacks in the DAFNE diary. Remember, answers to activities are also included in the back of the book. The DAFNE quiz and answers to the quiz are also included in the activities book. Make sure you are familiar with the activities and their answers referred to in the lesson plans for sessions during the course.

End transcript

 

A downloadable version  is also available in a PowerPoint format.

Unlike Remote DAFNE, you will be teaching the course content rather than confirming self-directed learning.

The lesson plan is your plan for teaching an individual session. The DAFNE and 5x1 DAFNE lesson plans in the curriculum follow the skills and processes outlined in the DAFNE philosophy.

The DAFNE lesson plans include active learning strategies and teaching methods that support experiential and social learning, so that you can deliver your sessions in a way that demonstrates the DAFNE philosophy in action.

The DAFNE lesson plans will help you to manage the group and any potential challenging behaviour. By demonstrating the DAFNE philosophy through your behaviour you will minimise the possibility of challenging behaviours. Challenging behaviours are more likely to surface if:

• there is no structure to your session
• you, as the educator, are the centre of the whole group’s attention for long periods of time; e.g. ‘talk and chalk’ delivery or general whole group discussion.

A good lesson plan:

• helps you to feel confident
• allows you to deliver an effective DAFNE course
• provides an opportunity for participants to achieve learning outcomes (essential, expected and optional content)
• facilitates an enjoyable learning experience
• ensures sessions have structure, flow and timing
• includes the resources you plan to use
• outlines your teaching methods and strategies
• is a tool to help you practise and reflect
• allows you to reflect and evaluate, as well as to develop and progress
• is your plan of how you will deliver each session.

Note: Familiarising yourself with the lesson plans will help you to develop an in-depth understanding of the curriculum and how sessions link together.

We recommend that you use the DAFNE lesson plans initially and adapt them, if necessary, for further course delivery.

It is essential when delivering DAFNE sessions to avoid a lecturing style or ‘chalk and talk’. This does not support health literacy. Activities encouraged in face-to-face DAFNE facilitation support the practise of new skills, working as a group and supporting each other. For example:

• pair discussion and feedback
• workbook examples
• problem solving
• work stations
• games and quizzes
• feedback and reflection.

The following sections describe techniques and skills that can support health literacy and facilitate effective course delivery, with specific examples from DAFNE sessions.

You are familiar with using the teach back technique from your experience of Remote DAFNE facilitation. In face-to-face DAFNE you have the opportunity to use the ‘show me’ method as well as teach back, as a communication confirmation method designed to improve health literacy. You can use it to confirm whether a participant has understood what you have been teaching by inviting them to ‘show you’ how they would put the teaching into practice, for example, demonstrate how to use digital scales to weigh their food without including the weight of the plate.

If a participant understands, they will be able to ‘show you’ the technique or process accurately. The technique also enables you to check that you have clearly explained information in a way that the participant understands.

The following teaching tip shows how to use digital scales. Once demonstrated, participants can show you that they understand how to use scales at lunchtime, and in the session counting CPs in everyday foods.

Teaching tip

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SUE

Fiona, it's really surprising, isn't it, how many participants are not aware of how to use digital scales?

FIONA

Oh, absolutely, especially if you've got some older participants who are used to the old scale system where they have a bowl and they just pour the ingredients in. I think with the digital scales, the important thing to remember is that you need to weigh the plate or the bowl or whatever you're using before you actually put the food on it, and then zero the scale, and then weigh the food. So, I'll just show you very briefly and very simply how that can be done.

SUE

Thank you.

FIONA

So we need to switch the scale on. And then it doesn't matter the size of the plate or the dish, you would just put the dish onto the scale. When it's on and balanced well, you would then press to zero it so you've then got a zero weight, and then you can add whichever food you're going to add. And the weight that you get will be just the weight from the food, and not the weight of the food and the plate added together. What would happen if somebody weighed the plate and the food?

SUE

One course participant did talk about the fact that she actually included the plate in the weight with the food, so she actually took double the amount of insulin that she needed to take.

FIONA

Yeah, quite easily done.

SUE

Very easily done.

FIONA

Because half the weight would have been the plate, and the other half would have been the food, so she'd have taken double the amount of insulin.

SUE

Yes.

FIONA

Yeah. Again, an easy lesson to learn and an easy mistake to make.

SUE

And it’s part of the group discussion.

FIONA

And group learning again.

SUE

It is another learning experience for everyone.

FIONA

Yeah.

End transcript

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This technique goes beyond asking closed questions such as, ‘Is what I have explained to you clear?’ or ‘Have you understood everything that you have heard?’ because you are asking the participant to demonstrate that they have heard and understood what has been communicated.

Watch the video to see how the show me technique is used as part of activity 35 in the session, mild hypos and driving. The activity is outlined in the lesson plan with reference to the course book and activities book to demonstrate an understanding of how to measure out an appropriate amount of a number of hypo treatments.

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Slide 1 narration:

Teach back, also known as the 'show me' technique, is a key element in the session ‘mild hypos' because it enables the participants to achieve one of their main learning outcomes – to show you that they can measure out the correct amount of an appropriate hypo treatment. The learning outcome does not relate to you demonstrating this as an educator. Provide scales, measuring jugs and calculators for the participants to use and choose a variety of different hypo treatments for them to weigh and measure. Ask your participants to use their Carb portion list or the food labels to work out the weight / volume of 1 ½ CPs then measure this out for each hypo treatment. If you’re using liquid hypo treatments, such as orange juice or cola, provide different sized cups, glasses and mugs so the group can visualise the required quantity in something they might use at home.

Slide 2 narration:

You can see an excerpt of the lesson plan for this session here. The lesson plan outlines the relevant activities for your participants to complete in order to achieve their learning outcomes. It also includes suggested resources as well as the relevant DAFNE flipcharts you may wish to use to support the group’s learning.

Slide 3 narration:

When facilitating this activity, your participants can use a number of different resources. Firstly, they’re going to measure out the amount of hypo treatment needed from those available to them on the DAFNE course. Encourage the participants to record the correct amount needed for orange juice, jelly babies, dextrose tablets and cola in activity 35 in the activities book. Refer to note 9 in the activities book. When they discuss the need to keep hypo treatments with them all the time, and after looking at the options, ask them to record in note 9 which ones they would prefer to keep with them, in their bag or pocket, at work, in the car and when they’re exercising. Allow time for feedback and reflect responses back to the group verbally. Recap the DAFNE guidelines using the Hypo treatment flowchart, Figure 31, if necessary.

End transcript

 

A downloadable version  is also available in a PowerPoint format.

Depending on the participant’s response, you will be able to clarify or modify information and use the ‘show me’ approach again, as necessary, to confirm that the participant has understood. Asking for explanations from other group members can be a helpful way of introducing peer support. Participants may understand each other more clearly than they understand you.

It is good practice to check that people understand the information they have been given regardless of their health literacy levels, so this technique can be used as a matter of routine with everyone in the group.

The 'show me' technique can also be used to confirm participants have understood how to:

• weigh out 1 CP of a food to aid visual estimation
• perform an accurate blood glucose or blood ketone check
• count their CPs accurately at lunchtime
• calculate and inject the appropriate dose of quick-acting insulin at lunchtime, based on their Glucose check and CP count.

This approach can be used in conjunction with the ‘teach back’ or ‘show me’ technique. You break down the information into small sections or ‘chunks’. After each ‘chunk’, you check the participant understands the information before you move on.

The DAFNE lesson plans include opportunities for ‘chunk and check’ at relevant points in session delivery.

Watch the video to see an example of using 'chunk and check' in the introduction to carbohydrate counting session to identify food groups and foods associated with them that participants know. 'Chunk and check' can be combined with the 'show me' technique in practical activities to check that participants have understood the content of the session and are able to achieve the learning outcomes.

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Slide 1 narration:

It is always helpful to start with what participants already know. In this case, the three main food groups of fat, protein and carbohydrate, and the foods associated with them; this discussion will confirm or clarify their knowledge to start with, and you can then ask the group to expand on this by identifying foods that don’t fit neatly into just one category but could be included in two or more of these main food groups because they contain significant amounts of more than one nutrient.

Slide 2 narration:

A ‘show me' activity is a useful way of confirming that participants have understood information you’ve discussed. In this particular activity, undertaken in small groups or pairs, the participants sort food models into those that contain carbohydrate, those that do not contain carbohydrate and those about which they’re not sure. This activity confirms their learning and encourages group interaction and peer learning. Providing the ‘not sure’ option reduces anxiety about knowing the correct answer, confirms that it’s ok not to be sure at this point, and provides opportunity for group discussion and clarification of the classification of these foods. For example, participants may place the alcohol food model or foods like burgers, sausages and foods with a crumb or batter coating, in the ‘not sure’ section. It’s not unusual for participants to be unsure about the carbohydrate content in these foods and whether it’s significant enough to affect their Glucose and to think about when considering insulin doses.

Slide 3 narration:

Practical activities can be done as a whole group or in smaller groups or pairs. Whole group activities may be less inclusive of participants who are reluctant to take part and you may miss the opportunity to find out how much such participants have taken on board. Smaller group activities or pair work can be more inclusive and promote interaction within the group and give you an opportunity to ‘check’ the learning more thoroughly.

End transcript

 

A downloadable version  is also available in a PowerPoint format.

The use of pictures, photographs and symbols can make a piece of health information more interesting, as well as helping to support what you are trying to say or to reinforce key messages.

However, inappropriate pictures, tables and graphs can cause confusion or send out the wrong messages. Pictures should add value to your information.

Using poor quality and inappropriate visuals may look unprofessional and may damage the perceived reliability of information given on the DAFNE course. The DAFNE insulin posters, flip chart, course book and activities book have been developed with health literacy in mind.

Watch the video that follows to see the annual review game, a visual resource that can be used in the long-term health and diabetes session to aid discussion of health checks and possible complications of diabetes.

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Slide 1 narration:

You are familiar with the DAFNE visual resources and when they are used in the course from the resources section in your lesson plans. The annual review game is a visual resource that can be downloaded from the DAFNE central resources area for use in the long-term health and diabetes session. You may wish to create your own resources for practical activities to use in your DAFNE sessions. If so, make sure that your pictures, table or graphs are high quality and add value to your information.

End transcript

 

A downloadable version  is also available in a PowerPoint format.

You will need to use your own local resources, such as food labels in some sessions. Make sure that they add value to your information and do not look unprofessional or undermine the reliability of the DAFNE course.

Visual aids to explanations can be helpful to illustrate key learning points or concepts that can be difficult to grasp through words alone.

The video clip that follows shows how to use a visual aid to explain the difference between the weight of some cooked and uncooked foods.

Teaching tip

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FIONA

Some of the participants find it difficult to get the concept into their heads about cooked food versus raw food. And they can’t understand that a food product may weigh more once it’s cooked, but the carb content remains the same.

SUE

I think it’s a very common misunderstanding, Fiona, and perhaps we could demonstrate with the orange juice.

FIONA

Yes.

SUE

If you’d like to …

FIONA

I think that’s a good idea.

SUE

… pass me the orange juice there.

FIONA

You want the orange juice over and a couple of glasses.

SUE

Yes. Thank you.

SUE

I’m just pouring the orange juice.

FIONA

So what are you?...

SUE

Just 100 ml.

FIONA

100 ml. Yeah.

SUE

I’ll put 100 ml in this glass and 100 ml in the second glass.

FIONA

So if you were to ask me about the carbohydrate content in each of those glasses I would say it’s exactly the same because they’ve both got 100 ml.

SUE

Exactly. Now I’m going to pour in some water in the second glass and fill that to the top.

FIONA

Yeah. So for some people, because that’s now almost double the amount, they would think that that glass has got more carbohydrate in it because it’s a larger amount. But all you’ve actually done is dilute the juice.

SUE

Yeah.

FIONA

So it’s exactly the same amount of carbohydrate as that one, although it looks like more.

SUE

Exactly.

FIONA

So it’s the same with cooked food. Although it may weigh more, it’s exactly the same amount of carbohydrate as it was before you started cooking.

SUE

Yes. It’s got the same CP content.

FIONA

Yeah.

SUE

Yes.

End transcript

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You may wish to use the demonstration in the video (or something similar) in your own DAFNE courses.

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Slide 1 narration:

In order to keep the session on track, it may be necessary to 'park' or 'bank' questions from participants. You may choose to make a note of these yourself, and save them to the ‘Parked questions’ flip chart. Alternatively, your participants may prefer to make a note of their own questions and add these to the flip chart themselves.

End transcript

 

A downloadable version  is also available in a PowerPoint format.

You are aware of banking or parking questions from your experience of facilitating Remote DAFNE. Banking or parking questions is a good way of not going off track in a face-to-face course if the discussion is unrelated to the immediate topic. On the wall have a pre-prepared piece of flipchart paper titled ‘question bank’ or ‘question park’.

Ask the participant to write their question on a sticky note and add it to the question bank. It lets participants know that you won’t forget the question and that you will come back to it at the relevant time. It also reminds you to come back to the question. You may find common themes to some questions or topics and the question bank will allow you to combine them.

Team teaching

Delivery of face-to-face DAFNE course formats is based on a team teaching approach, when two or more teachers cooperate, deliberately and methodically in the teaching process to teach the course, assess the learning and evaluate each other’s performance.

Team teaching draws on the expertise and knowledge of the team to promote effective learning and expose learners to a variety of different teaching styles.

Team teaching is particularly useful in the daily (or weekly) discussions of DAFNE diaries or CGM downloads, and the daily lunchtime CP counting and insulin adjustment sessions, when participants can benefit from the expertise of DAFNE educators from different disciplines.

You may have delivered Remote DAFNE alone or with a colleague. The following videos demonstrate a team teaching approach to the discussion of DAFNE diaries or CGM downloads.

This session in a DAFNE course differs from remote DAFNE or 5x1 DAFNE as the group are reviewing diaries at the beginning and end of each day, focusing on identifying patterns in Glucose as they develop over 48 hours, rather than patterns that can develop over a week.

Participants may or may not see Glucose patterns developing by Wednesday of the DAFNE course. Participants who are not able to identify patterns may become frustrated by a perceived lack of progress if their Glucose is not in their target range.

In this situation, part of the educator role is to encourage participants to ‘wait and see’ rather than jumping in and making insulin dose adjustments when the evidence for making a change is not clear.

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Slide 1 narration:

The video you’re about to watch demonstrates the Glucose diary discussion within the group; it shows the ways in which both educators work with the group and with each other to support a participant to identify an action plan.

Video transcript:

Sue:

Welcome back from the break everyone, we’re going to be looking at your Glucose diaries in this session; as before, we’ll spend a few minutes looking at each other’s diaries or downloads in turn, you’ll have the opportunity to talk through how things have been going, what changes you’ve made, how they’ve worked and think about your action plan overnight and the next few days - so who’d like to go first?

Paula:

Everyone’s eager this afternoon! This doesn’t normally happen until Wednesday!

Faye:

Can I go first please? I’ve got to pick my daughter up at 5 from the childminder and might have to go early and I really wanted to talk this through?

Sue:

OK, no problem, just remind me, have you got a Glucose diary or a CGM download?

Faye:

I’ve got CGM but I’ve been writing down my sugars in my diary. I find it easier to see patterns than using the lines and graphs.

Sue:

Do you want to pop your diary under the visualiser?

Paula:

Can everyone see that clearly?

Majula:

Yeah, that’s fine now.

Sue:

OK, let’s just take a few minutes to look at Faye’s diary. Right then, Faye, before we start, remind us of your targets, your ratios and your BI doses.

Faye:

My targets are the DAFNE targets and my ratios are 1:1 but my BI’s changed a bit this week.

Sue:

Ok, so hold that thought for a second – who can tell me what the DAFNE targets are?

Gillian:

Is it between 5 and 7 in the morning, and then 4 and 7 at lunch and tea time?

Sue:

Yep, spot on, how about bedtime?

Dave:

Between 5 and 9 I think, but I’d rather be closer to 9 than 5!

Sue:

That’s right, thanks for that. Faye – how do you feel about the bedtime target cos Dave isn’t comfy going to bed on a 5?

Faye:

I’m happier going to bed on a 7 or an 8.

Sue:

Ok, so let’s go back to what you’ve changed this week. Talk us through what’s been happening this week and how you’ve managed things.

Faye:

Well I split my BI on Sunday night to 8 and 8 like we discussed a couple of weeks ago. On Tuesday night we decided we’d ALL check at 3am, just to see what was going on, it wasn’t just Estwar having to wake up at 3!

Estwar:

Well thanks for that Faye! I’m so pleased I wasn’t the only one with a 3am alarm call!

Sue:

And what did you find out by doing that Faye?

Faye:

I saw that my correction at bedtime worked cos I was back on target at 3am. My Glucose also stayed steady till breakfast, so I decided to keep my BI on 8 units at bed.

Sue:

Can everyone see that? If we have a closer look - her Glucose was 12.2 before bedtime, 4 hours after her evening meal, took 2 unit correction, hoping to bring that glucose down into target and it worked. 7.1 glucose before breakfast. So what would anyone else expect a correction of 1 unit to do to your Glucose?

Estwar:

Drop it by 2 – 3?

Pauline:

I’ve gone with dropping mine by 3 so I don’t go too low until I become more certain.

Sue:

Good idea Pauline, so you feel safe doing corrections that way. How about anyone else?

Dave:

I’m the same, assume it’ll drop me by 3 until I know for sure.

Sue:

OK, thanks for that everyone, Faye – what was the next thing you tried?

Faye:

Next I wanted to check my morning BI. I’m higher than I’d like to be and corrections aren’t working very well. My action plan from Wednesday morning was to delay my lunch that day and see what happened!

Spencer:

I did the same, but it was really odd cos I’d always thought I HAD to eat every 4 hours and I HAD to have carbs at every meal AND have insulin at every meal, so it was really weird.

Paula:

Sue can I just jump in here?

Sue:

Yeah please do.

Paula:

Jas, you mentioned this on Tuesday when we talked about assessing your BI, remind us what you shared with us then.

Jas:

If I can remember! Was it when I said about not needing to inject for every meal – that bit?

Paula:

That’s it, what was it you said?

Jas:

Just that it’ll be great to have free choice on a menu when I go out and not always have to order extra sides to make sure I’ve got enough carbs; my mum and dad love to take us to this posh place for our birthdays but you always have to order veg etc as extra and there’s always been this pressure to order chips or potatoes when I don’t always really want to! Now I know I don’t have to but my mother’s still a bit sceptical!

Paula:

I guess it’s a hangover from when she was looking after you as a child so she’s still very protective?

Jas:

Exactly that yeah, but I’m old enough now to do this myself and she’s just going to have to get used to it!

Sue:

Ok guys, let’s get back to Faye’s diary and her action planning; so Faye, you delayed your lunch yesterday, talk us through what happened and what you found out.

Faye:

I’ve never done this before so it’s actually really, really useful! I started the day on 7.1. Then I had 4 ½ CPs for breakfast so I rounded up my insulin to 5 units because I was just over the top of my target. By lunch I was 10.6, I had a black coffee and nothing else and then by 3 o’clock, I was 13.7.

Sue:

And what did you do then?

Faye:

I had a snack and took some QA with a correction.

Sue:

And what did you decide to do as a result of delaying your lunch and assessing your morning BI?

Faye:

Well this morning, I put my BI up from 8 units to 10 units. I’ve just checked my CGM and I’m 6.4 so I’m happy with that!

Paula:

So basically, you’ve sorted out your BI and it’s only Thursday! Well done Faye!

Dave:

Yeah, that’s amazing, makes me realise that even though I haven’t made as much progress as other people, this DAFNE stuff must work!

Sue:

I guess it’s helpful to learn from each other isn’t it?

Majula:

Yes that’s good – so if someone else messes up we know not to do the same thing!

Faye:

Thanks for that Majula! No pressure then!

Sue:

So let’s continue the learning from each other theme, Faye – tell us what your action plan is this evening.

Faye:

I’ve checked my BI so I want to move on to my tea time ratio. If I don’t correct, I go up.

Sue:

So what specifically are you going to do now?

Faye:

I’m going to check my Glucose before tea. Then I’m going to weigh my carbs, I’ll have something easy to work out. I’ll only have a carb free drink after tea. And then I’ll check 4 hours later. Then I’ll be able to see what my QA’s doing.

Sue:

OK thanks for that, and why d’you think Faye’s going to wait 4 hours before checking her Glucose at bed?

Gillian:

Is it because that’s how long her insulin lasts from tea time?

Sue:

Absolutely, yes, Faye’s on a quick acting insulin at meals – remind me which one?

Faye:

Humalog

Sue:

Yep, I remember now – that’s why Faye’s going to wait 4 hours. Faye you said you’d have something easy to work out for tea?

Faye:

I’ve got some individual portions of lasagne in the freezer. It tells you how many carbs per portion on the label.

Paula:

What will you have with it?

Faye:

Just a salad on the side.

Sue:

Ok, so you’ve got a plan for tea, and a plan for your Glucose checking. How will you know if you need to increase your ratio?

Faye:

Well if I go up by more than 1.5 by bedtime. I might just do it tomorrow just to be sure. I’ve only just increased my morning BI today.

Sue:

Ok, you’ve got a plan you’re happy with there, so let us know how you get on when we come back tomorrow! Anything else you’d like to think about this evening?

Faye:

No I don’t think so, I’m happy just to keep it simple.

Sue:

Ok, thanks for that Faye, who’s going to go next?

End transcript

 

Watch the video that follows for some session-specific teaching activities. These teaching activities are based on small group or pair work and are outlined in the lesson plans with reference to the course book and activities book.

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Slide 1 narration:

As part of face-to-face course delivery, you’ll be teaching DAFNE principles using practical, classroom based activities with small groups or pairs of participants. Classroom based activities require planning and resources to cover the content of the session and to enable participants achieve the learning outcomes. The following are some suggestions and teaching tips for specific course sessions.

Slide 2 narration:

For this session, you’ll need kitchen scales along with the following: an assortment of different sized plates and bowls for participants to measure their portion into; a selection of different household measures that participants may have at home such as measuring cups and spoons; a variety of culturally appropriate cooked foods that contain carbohydrate like cereals, different types of bread, rice, pasta, potatoes and fruit; as well as 1 CP of individual cooked foods already weighed and plated to aid visual estimation. Think about where you will source cooked, dried and fresh foods from. Will your catering department supply them, or will you supply cooked foods from your own home? How will these be budgeted for and if you are cooking them at home, when will you do this? In this session, participants will complete activity 14 in their activities books. In order for them to do so, you also need to provide an assortment of food labels for them to use to count CPs in their own serving size. Food labels should include some containing slowly digested carbs that may not need to be counted and carb values for suggested serving sizes and per 100 g.

Slide 3 narration:

If your venue is large enough, create work stations around the room where participants can complete the activities in their activities book and those outlined in the lesson plan. Provide clear instructions for each work station and, if necessary, write the steps for the activities on the flipchart and keep it in the line of sight of participants as they work through each activity. For example, in activity 15 – step 1: put your own portion of food (cereal, rice etc.) onto a plate or into a dish and estimate the CPs in your own portion (your fellow group members can also help you to ‘guess’). This is visual estimation. Write your estimate in the ‘guess value’ column. Step 2: weigh your portion size to work out the ‘actual’ CP value and write this in the ‘actual value’ column and compare the results. Step 3: look at the pre-weighed and measured foods of 1 CP (rice, pasta, potatoes, or chips). Use these to help you make a more accurate visual estimation of the CPs in your own serving size. Estimating the CPs in your own portion in these activities can be helpful because you’ll build up a visual memory so when you’re eating away from home (when you may not have access to measuring cups, spoons and digital scales) you’ll feel more confident about the estimates you make. We recommend that both educators are present in the session and both educators circulate between work stations to offer support where needed.

Slide 4 narration:

The activities book contains scenario based activities, for example, managing physical activity and exercise, illness management and sick day rules. These can be completed in pairs around the main table. An alternative method is to print out the answers to the activities and place them around the room, then ask the participant pairs to circulate around the room to find the answer that matches the scenario they have been given. This method is useful if you need to increase the energy in the room, for example, if the session is just after lunch or participants have found a previous session challenging.

Slide 5 narration:

The insulin regimen session uses many visual resources to help participants become familiar with the action times of their own insulins. You can increase the energy level in the room by making the participants move around the room at the beginning of an activity. So, for example, prepare a flip chart in advance with six sections, each one labelled as a type of insulin. Section 1: intermediate-acting (i.e. isophane). Section 2: long-acting insulin analogues. Section 3: ultra-long-acting insulin analogue. Section 4: quick-acting analogues. Section 5: ultra-quick-acting insulin analogues. Section 6: other (mixed insulin or older types of QA / BI). Emphasise to your participants that ‘quick acting’ refers to mealtime insulin, not to be confused with ‘rapid acting’ which refers to the type of carbs used to treat a hypo. In this activity, ask your participants to write their own insulins on post it notes and add them to the flip chart in the relevant section. Alternatively, you may like to create and use an insulin sorting game or quiz.

End transcript

 

A downloadable version  is also available in a PowerPoint format.

Before the workshop, be familiar with the lesson plans for the sessions you are going to deliver. Consider other ways you might cover the session content and enable participants to achieve the learning outcomes. Make a note of your ideas in your training handbook for discussion as part of the workshop.

Microskills are an array of small communication skills used in high-quality interpersonal communication. We use many of these skills all the time without even being aware of it. You have experience of using these skills as a Remote DAFNE educator and they are just as important in face-to-face DAFNE courses. Here is a recap of microskills.

Validation

Validation doesn’t necessarily mean that we agree with what someone is saying. It just means that we are deeply listening and acknowledge what they are saying and feeling. This implies that we hear and understand them and that we can see the issue from their point of view.

Active listening

Listening to verbal and non-verbal cues helps us to understand others’ experiences. So even if they come from a differing perspective, it’s about trying to be in the moment and putting yourself in their shoes.

Watch the video that follows about picking up on non-verbal cues in a face-to-face learning environment.

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Slide 1 narration:

Face-to-face DAFNE courses allow you the opportunity to observe a wider range of non-verbal cues than those you might observe in Remote DAFNE, as people in a room together interact directly with each other. Read the room, be aware of non-verbal cues that suggest engagement such as eye contact, leaning in, looking alert; these are all signs that your session is going well. Signs of disengagement can include agitation or defensiveness, and are a signal to change the pace or use validation to show that we are listening and to acknowledge what participants are saying and feeling.

End transcript

 

A downloadable version  is also available in a PowerPoint format.

Say less

This requires practice to not allow yourself or other group members to jump in before the person has finished what they need to say. This will allow greater understanding of what a person is trying to say and can lead to far clearer communication within the group.

For example, if someone says, ‘It’s impossible to count carbohydrate all of the time!’, it is very tempting to jump in and say, ‘Oh, it’s not too bad, we have digital scales, carb counting books, apps, etc.’

Instead, individuals would feel truly heard if you said, ‘Yes, tell me why you feel that it is impossible.’ We can help by hearing and validating these experiences and helping the group to learn from each other.

These skills are based on listening. DAFNE sessions include time to listen and value participants’ contributions.

Equalising participation

Ensure everyone has the opportunity to speak. Not everyone needs to participate at the same level, but we should at least give them the opportunity to do so. If we do not scan the room, notice and provide the space for people to participate we may be missing out on valuable contributions. In a face-to-face group it is likely that there will be more direct communication between participants, unlike Remote DAFNE, where less communication goes through the educator. It is likely that you will have less control over the conversation than in a Remote DAFNE group.

Normalising

People need to be aware that what they are feeling is normal or their experience is normal. This often helps them to say things more freely. Be careful not to take over the person’s story; for example, ‘Oh, that’s terrible, the same thing happens to me when …’

A good example could be ‘Urine infections and thrush are very common in people with high Glucose’ or ‘It’s normal to feel distressed when you are first diagnosed.’ These skills are based on valuing the contributions of the group.

All these microskills are based on developing a sense of self-awareness and awareness of others so that we can communicate effectively with others.

Read the OzDAFNE facilitator numeracy supplement in your DAFNE and 5x1 DAFNE curriculum. The supplement outlines eleven methods that can help you to facilitate numeracy skills more effectively.

These eleven methods support the DAFNE philosophy by:

• valuing prior experiences
• including active learning strategies supported by the DAFNE workbook
• using DAFNE resources, including pictures
• using higher order (Socratic) questions
• employing a facilitation style that challenges misconceptions and encourages reasoning.

Make sure you are familiar with the content of the OzDAFNE facilitator numeracy supplement. Some questions in the end-of-unit knowledge assessment relate to the content of the supplement.

You can minimise the opportunity for challenging behaviours by taking the focus away from you when you deliver your sessions. The easiest way to do this is to use the DAFNE lesson plans, which include small group activities and active learning opportunities.

Teaching tip

Download this video clip.Video player: nc3612_dafne_2018_vid040.mp4

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Transcript

FIONA

Here's something for you to think about.

SUE

Good.

FIONA

We all want to avoid lecturing and probably want to be a bit sparkly and charming

SUE

We all present differently.

FIONA

We don't have to deliver a session in exactly the same way that we've observed someone else delivering that session.

SUE

Just as well, because we all use different explanations, illustrations, and resources and activities.

FIONA

But we do have to make sure that we cover all the session content and make sure that the learners achieve their learning outcomes. And we have to do that keeping the group running in the right direction, keeping the DAFNE philosophy and protecting everyone in the group. And you need one of these. A structure can help you to do this. And the standard lesson plans are structured in this way so they can help you to deliver your sessions.

SUE

It's important to ask lots of open questions, to be non-judgemental, but to keep to the content of that particular session.

FIONA

Absolutely. Just stick to the plan and be professional.

End transcript

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Educators have different personal styles and approaches. Be yourself – don’t be afraid to express your own style:

• be relaxed and non-judgemental
• encourage participation from the group and from individuals
• respond to group atmosphere
• encourage problem solving
• include clear explanations and use appropriate language
• encourage reflection.

Adopt a style you are comfortable with. Appropriate humour and banter make for a more enjoyable and memorable learning experience. Stories, humour and anecdotes can help participants to understand the context, importance and relevance of the learning (but remember not to ‘over-share’!).

Your strategies and style of delivery should reflect adult learning principles and the DAFNE philosophy.

Work with your co-educator. Effective teamwork and good rapport with colleagues supports an effective learning environment and demonstrates peer support.

Be professional. The DAFNE process can reduce barriers between the educator and the participant, which can sometimes be challenging.

Putting group management theory into practice is not always straightforward. Each group is different, and presents different challenges. Courses do not always run as we would hope – often the learning experience is an imperfect one.

Remember, we learn as much (often more) from an imperfect experience as from a perfect one. Admitting imperfections and learning from errors are as important as reflecting on your success in becoming an effective DAFNE educator.

A key educator skill is to be able to elicit evidence from the course participants that they understand the content and can apply it where appropriate; e.g. insulin adjustment or CP counting. You are familiar with using Socratic questioning and open questions from Remote DAFNE facilitation and this skill is equally important in face-to-face DAFNE courses.

As a reminder, Socratic questioning uses (mainly) open questions in a systematic and logical way to encourage critical thinking. These questions are used to explore ideas in depth, promote independent thinking, give participants ownership of what they are learning and move them towards their goals.

There are six Socratic question types:

• questions for clarification
• questions that probe assumptions
• questions that probe reasons and evidence
• questions about viewpoints and perspectives
• questions that probe implications and consequences
• questions about the question.

We have also provided more information on examples of all the question types  and when to use them.

Even if there isn’t a logical order to the questions, asking open questions is one of the best ways to stimulate group interaction.

Sometimes it can be difficult to maintain a line of questioning when group members are contributing to a lively discussion. This often happens, you may have experienced this during Remote DAFNE facilitation.

You can help the group to stay on track by:

• referring to your group agreement: ‘I’m conscious of the time…’
• banking or parking questions: ‘That’s a good point, add it to the question bank and we will come back to it …’
• interjecting with a summary of the discussion and refocusing the group on the task at hand.

The following activity will help you to think about how you might use open questions in the morning and afternoon individual dose adjustment sessions as part of a DAFNE course.

Teaching tip

Download this video clip.Video player: nc3612_dafne_2018_vid041.mp4

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SUE

As a good DAFNE presenter, I've prepared something in advance. Let's think about the questions and the Socratic methods that we can use. It's critical.

FIONA

Yes.

SUE

And here are some tips. Asking participants what is the main issue for them.

FIONA

So what's significant here? An example of an open question, I could ask, what else could be having an effect, rather than saying, I think the jog he had last night had an effect.

SUE

And now this?

FIONA

What?

SUE

A pause, giving the participants time to answer the question.

FIONA

Oh. And don't answer your own questions.

SUE

No, let them follow it up, and acknowledge their contributions.

FIONA

I like this one. Draw as many participants as possible into the conversation.

SUE

And ask for their thoughts. What does the group think?

FIONA

Periodically summarise key points. You may want to write them down like you have here.

SUE

See, I told you I prepared earlier. So remember, significant questions, use pauses.

FIONA

Don't answer your own questions.

SUE

Follow up, praise contributions, draw on the group's discussion and their experience.

FIONA

And summarise. Well done.

SUE

Thank you.

End transcript

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Goal setting and action planning are core parts of a face-to-face DAFNE course, just as they are in Remote DAFNE. Action planning should form part of the feedback, reflection and summary of every session (particularly the session at the end of each day), and if possible, should relate to participants’ goals. You are familiar with goal setting and action planning from your experience as a Remote DAFNE educator. This section is optional and does not contribute to your digital badge.

Visit the additional information section  for a recap of goal setting and action planning.

There are lots of theories about motivation. Here are some ways to think about what you can do as an educator to increase motivation and help participants to achieve their goals.

In a DAFNE course we use the Expectancy – Value Theory where:

We also use a confidence rating scale (1–10) and an importance rating scale (1–10). Where both these scores are high, motivation will also be high. If a score is low, we can ask ‘what would help to make the score go up?’

The answer may help to identify which parts of the course might be most useful to a participant, or how our actions and attitudes might help a participant get the most out of the course.

Educators can help to increase motivation by:

• Getting and keeping participant attention
  • Arouse curiosity
  • Share a surprising piece of information
  • Say something provocative (but not inflammatory)
  • Use gentle humour (not directed at a group member)
  • Involve the participants in an activity
  • Ask a question to promote discussion
• Highlighting relevance
  • Draw from the group’s experience
  • Connect what you are teaching with life experiences
  • Let them know what they can ‘take away’ and use immediately
  • Let them know what will be useful in the long term
• Building confidence
  • Be clear about what is expected so that there are no surprises.
  • Don’t make the course more difficult than it needs to be: follow the timetable so that sessions build in difficulty as the course progresses. Don’t move a session from the end of the course to the beginning – sessions build on successes in previous sessions.
  • Provide opportunities for success through activities and scenarios, so that participants can demonstrate their understanding.

Your behaviour as the group facilitator can either help or hinder how the group works together. This applies equally to face-to-face DAFNE courses as it does to Remote DAFNE courses.

This section is a reminder of basic group management techniques, and encourages you to consider how you will behave when you are facilitating and managing a face-to-face DAFNE course.

We all have different learning and teaching styles, which will be different in different situations or with different people. You may not feel comfortable using a group management approach that works well for a colleague.

Every DAFNE course is different because the participants are different; group management skills are important to ensure everyone gets the most out of the course.

Remember that the core of effective facilitation is to:

• be true to yourself; always be genuine and honest with course participants and try to establish rapport
• be willing to consider issues from the other person’s standpoint; try to understand how participants feel about the course
• accept participants for what they are in a non-critical and non-judgemental way; respect their experience and think positively about their ability.

The following are tips that may help you to manage challenging behaviours in a group.

Noticing and naming

This is a good way of alerting people to their behaviour, but you want to do this without ‘shaming’ anyone. For example, ‘I notice that people seem to be talking all at once’ or ‘The group seems flat after this session.’

If the energy is low because of a topic, you may find that a short discussion about how they feel might help to re-energise the group. If something has been said, then bringing it to the fore might help to clear the air. If people are tired, doing an energiser like jumping up and down, can help the energy.

Sitting with hotspots / difficult situations

This can happen when strong feelings are expressed, when conflict erupts or when people get upset or angry. It is good to sit in difficult situations even when people want to run, avoid or make a joke of it. It’s often difficult for us to ask more about a difficult situation because we are trying to pretend that it is not happening. When we do that, we are not at the service of the individual or the group.

We need to ensure that difficult situations are dealt with. As an example, when talking about complications of diabetes, someone starts crying. It would be very tempting to take the person out of the room and keep the session going. However, we are then not at the service of the group because emotions are left up in the air. We need to hold the space. This allows people to express their feelings, to be heard and validated, and move on. It takes lots of practice.

Standing by

During particularly powerful moments or ‘hotspots,’ we need to support people who are expressing what is difficult to say, even if it’s not said in a ‘nice’ way. At the same time, we need to stand by those who are having difficulty listening to it; for example, when someone gets angry because they feel that DAFNE is not helping them.

Instead of getting defensive, we as facilitators need to listen to the person’s feelings and let them know that we have heard them by saying ‘ok’ or ‘yes’ or ‘wow, those feelings are powerful’. You can then ask them more.

To manage group learning you must be prepared to give the group direction, manage expectations and challenging behaviours, and keep the group on task. Refer to group management handouts 1–3 (available in the resources section) for tips on managing the group. Some of these strategies may be familiar to you, some may be new because you haven’t considered using them in Remote DAFNE. Make sure you are familiar with the content of these handouts as some questions in the end-of-unit knowledge assessment relate to the content of these handouts.

You may have observed educators with group management styles that are different from or similar to your own when you have been facilitating Remote DAFNE. It is likely that you have management strategies you are comfortable using when facilitating Remote DAFNE.

To help you think about your own style, and how that will work in a face-to-face DAFNE course, consider the following three scenarios.

In each scenario, a group participant’s behaviour is having a negative impact on the rest of the group. It is part of your role as a DAFNE educator to manage challenging behaviour and maintain an environment that helps people to learn. In each scenario you have a choice of strategies you could use to manage the situation. Record the strategies that you feel comfortable using.

A challenging behaviour that surfaces in a face-to-face DAFNE course can seem more immediate or real, as you are occupying the same physical space as the person expressing their feelings and acting on them.

To recap, the skills and processes that support the DAFNE philosophy are:

• using participant experience as a starting point in each session
• having a structure to each session that encourages skills development, peer support and learning through experience by practising the skills
• using a guiding style of open questioning (the Socratic questioning technique) to encourage problem solving, challenge barriers and present other treatment options
• encouraging personally relevant goal setting and action planning to enable participants to move towards their goals.

The skills and processes outlined in the DAFNE philosophy focus on those required to facilitate learning. These skills can also help you to manage group behaviours.

Often educators are able to reduce challenging behaviours or eliminate them from their sessions through facilitation and session planning.

To help you to consider how managing a challenging behaviour in a face-to-face DAFNE course may be different to managing a similar behaviour in a Remote DAFNE course, we have prepared three short videos for you to watch and review. In the videos all group members are attending a DAFNE course (5 days in one week) and using blood glucose checking rather than continuous glucose monitoring (CGM).

In this video the educator is facilitating a session in which the group share their blood glucose diaries. In this session individuals are reflecting on their own application of DAFNE principles of CP estimation and insulin dose adjustment. They are looking for patterns in their Glucose to help them problem solve, make decisions and action plan for any changes they would like to make. The session is key to the face-to-face DAFNE course as it is in a Remote DAFNE course and provides opportunities for modelling, mastery, reflection, experimentation and peer learning.

Activity 11: Anger

Timing: 20 minutes

Part 1

Download this video clip.Video player: nc3612_dafne_2018_vid034.mp4

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Transcript

DEAN

This is my DAFNE session. I'm late. I had a terrible night. Sometimes I wonder about these sessions. I'm not sure the approach is working.

EDUCATOR

Morning, everyone. Come on in. Don't be shy. Have a seat. It's great to see you all again.

FRED

You too.

EDUCATOR

Yeah, guys. Just sit there where you were yesterday is fine. OK. And you've remembered to bring your diaries back in as well. That's great. That's what I like to see. OK, so how is everyone this morning?

[INTERPOSING VOICES]

Good. And you're finding the course good, or--

FRED

Challenging, yeah.

EDUCATOR

Yeah?

STEVE

Getting there.

EDUCATOR

Great. So let's get started, shall we? Hi, Dean. You're happy to go first this morning. Thank you very much. And so you let me know earlier that you didn't have a very good night last night. I think it would be useful for you to go first, so we can have a little talk about what's happening. And is that still OK?

DEAN

Fine.

EDUCATOR

OK. I mean, if you'd rather not talk through your diary today, that's fine, too.

DEAN

Go ahead.

EDUCATOR

OK. So talk us through what happened between leaving the session yesterday and arriving back here this morning. Which part would you like to talk about first?

DEAN

Well, to be honest, I nearly didn't come back. The way it messed me up, I think I was better off before.

EDUCATOR

OK. So you think you were better off before. Well, let's have a little look at your diary and see if we can figure out what's been happening, OK? So I can see that you had a hypo last night. Is that what you'd like to talk about first? So what was your BG like before the course?

DEAN

Well, nobody's ever been able to get it right, but I wasn't having two hypos a day, like I am now.

EDUCATOR

OK. So you mentioned on Monday that you wanted to join the course so that you could get a more predictable BG and a better HbA1c. That's your goal. Well, we aren't quite there yet, but it has only been two days.

If we have a little work through the stepwise approach, perhaps we can have a little look and see why the hypos are happening and how we can prevent them from happening in the future. OK. So let's start with the evening meal last night, Dean. What were the CPs for that?

DEAN

Well, I had fish and chips on the way home.

EDUCATOR

OK. So you had a takeaway.

DEAN

Yes.

EDUCATOR

And how did you work out the CPs?

DEAN

Well, there was CPs in the chips and in the fish batter. It wasn't a huge portion, so I guessed at maybe eight. I've been counting carbs for years, so I went off the picture that we had in class. I didn't think I was far out.

EDUCATOR

OK. So you used a visual estimate based on the picture that we saw yesterday because that's all you had to go on. OK. So thinking about the stepwise approach, how can we rule out that CP counting is what's knocking the BG out of sync at the moment?

FRED

Not at the moment, but it could be something else.

EDUCATOR

Dean, are there any other factors in the other causes section that might have affected your BG?

DEAN

No. I didn't exercise. No snacks. I didn't have anything to drink.

OLGA

And what about the corrections you've taken every night after you've eaten?

DEAN

Well, it's never been a problem before. I always correct before bed. It was never a problem before the change made it twice a day basal. I was fine on once.

EDUCATOR

OK. So it sounds like you think it could be the basal. Let's think about insulin. So Dean, thinking about the stepwise approach, what does it say about the action on your QA insulin?

DEAN

It's about up to 15 minutes. Peaks at about 60 and then lasts for two hours.

EDUCATOR

OK. So when you took your QA at half past nine last night, when do you think it might run out?

DEAN

Well, it takes two hours, so about half eleven.

EDUCATOR

And what does everyone else think?

FRED

Well, I thought it lasted for four hours. I mean, it does for me.

DEAN

Well, everybody is different. Mine last for two.

EDUCATOR

Now, the manufacturers say that it lasts between two and five hours, but for most people it lasts around four. Let's think about corrections. Dean, can you talk us through your correction last night?

DEAN

Well, I took an extra two units of QA because my BG was high, and I thought I'd take a little less than the night before so I wouldn't have a hypo, but I had one anyway.

EDUCATOR

OK. So you are following the DAFNE guidance and not having any more than four units of correction for now, until you figure out what works for you.

DEAN

Yes.

EDUCATOR

What else did we say on Monday about corrections?

DEAN

I don't remember.

FRED

We said not to correct between meals. You have to leave it three or four hours after an injection. So just correct at the next meal. Four hours works for me.

EDUCATOR

OK, Dean. So based on previous experience, you think that QA lasts for two hours. What do you think might happen if you were to correct after two?

STEVE

Is that what you're calling insulin stacking? Where you get two doses working at the same time, which would cause a hypo?

OLGA

Looking at your diary, Dean, do you think it might last four hours? Your hypos are both one or two hours afterwards. Maybe you don't need it.

DEAN

I don't think that's right. That might be right for you, but it's not right for me. I think it's the basal.

EDUCATOR

What could you do to check that? What other information do we need?

DEAN

So you want me to get up at 3 o'clock in the morning? Priceless.

STEVE

How about having an earlier meal tonight, then that way you definitely have four hours between the meal and your bed checks. So if you left it, then you'd be able to see how long your QA lasts.

DEAN

What about fitting diabetes around my life and not my life around diabetes? You want me to get up at 3 o'clock in the morning and then change all my meals? Listen, if this is the way DAFNE is going to be, then stuff it!

STEVE

Look, I'm not saying that you do that. I'm just saying just do it for tonight. Like a bit of an experiment.

EDUCATOR

OK, Dean. You seem angry. Can I ask why that is?

DEAN

I am angry. You're making me angry. All this stuff, it's like you're blaming me.

EDUCATOR

Well, I'm sorry you feel that way. I'm not here to make you do anything or make you feel like you're doing anything wrong. This is just another way of doing it. It's another tool for you to have. And sometimes I get enthusiastic because I really have seen this work for so many people before. If I've said or done anything to make you feel bad, then I really am sorry.

Dean, I'm really impressed that you've come on this course and tried new things, even though you haven't had a very positive experience with your diabetes team in the past. Looking at your diary, I can already see that you were in target from midday yesterday up until 9:30. That's a third of the day cracked already, and it's only been two days. To me, that seems like a real positive. So what do you all think of Dean's diary so far?

OLGA

Oh, I understand how it makes you feel crazy angry. We've all felt like that at some point.

FRED

Yours is better than mine at the moment. I've been having hypos every night for years. I just figured out yesterday that I just must have too much insulin somewhere. You're probably the same.

DEAN

Maybe.

EDUCATOR

OK. So I don't think looking at your diary is helpful right now, so I'm going to stop, if that's OK with you.

DEAN

Fine.

EDUCATOR

OK. How is everybody feeling? We can either carry on and go straight onto Olga's diary or, if you prefer, we can have a short coffee break and come back and do the diaries afterwards. We'll still have a break at the usual time, but maybe just a bit of a shorter one. What would you all like to do?

[ALL AGREEING]

EDUCATOR

Dean, I'd really like to understand what just happened. I'd appreciate it if we could have a chat on our own at lunch time. Would that be all right with you?

DEAN

Yes.

EDUCATOR

Great. Thank you.

DEAN

OK. No problem.

End transcript

Download

 

Interactive feature not available in single page view (see it in standard view).

As you watch the video, think about:

Which educator behaviours can you observe being used to manage the challenging behaviour, diffuse the situation and protect the group?

If you need to refresh your memory about educator behaviours refer to Educator behaviours that demonstrate the DAFNE philosophy, which is available in the resources area.

Record your observations in your workshop pack.

Reflect on what you have observed. What will be different for you when you are in the room delivering face-to-face DAFNE courses? What might you have done differently? Record your reflections in your workshop pack.

Bring your observations and reflections to the workshop. You will have an opportunity to discuss them there.

In this video the educator is facilitating a session in which the group share their DAFNE diaries. In this session individuals are reflecting on their own application of DAFNE principles of CP estimation and insulin dose adjustment. They are looking for patterns in their Glucose to help them problem solve, make decisions and action plan for any changes they would like to make. The session is key to the DAFNE course and provides opportunities for modelling, mastery, reflection, experimentation and peer learning.

Activity 12: Talkativeness

Timing: 20 minutes

Part 1

Download this video clip.Video player: nc3612_dafne_2018_vid035.mp4

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Transcript

EDUCATOR

Hi. Olga. So could you just talk me through what your action plan was for last night?

OLGA

Sure. I was extra careful with my CP counting. I think I got it wrong at breakfast yesterday. And I did a BG check at 3:00 this morning.

EDUCATOR

Oh, that’s right. You were wondering about …

FRED (VOICEOVER)

She always goes to Olga first. I think it’s because she’s a bit of a misery. I reckon she wants to flush her out. I love this approach, but I can’t stand it when someone drags their feet. I could show Olga how it’s done properly.

EDUCATOR

OK. So we are looking at what happened between leaving here yesterday and coming back in this morning. Which area would you like to focus on first?

FRED

So slow. I want to know what you got up to last night. Must have been something pretty energetic to get your BG down to 4.0. What were you doing? Come on. Tell you what, I don’t know about you, but I have to keep a banana by the bed just to keep my energy up, if you know what I mean. Dr Brown says that sex can really mess up your blood glucose levels, eh Amy?

EDUCATOR

Ha. I’m just wondering if we can all remember what we agreed on Monday? That we would be kind to each other and respect each other? We need to listen to what Olga wants to say now.

FRED

Sorry.

EDUCATOR

But you can jot that down as a parked question, and we will come back to the effects of sex when we talk about exercise in tomorrow’s session. Or you can add it to your list of questions to ask your doctor. Now, Olga.

OLGA

I was extra careful with my CP counting. I think I got it wrong at breakfast yesterday, and I did a BG check at 3:00 this morning.

EDUCATOR

Oh, that’s right. You were wondering about your BI at night time. OK. So we’re just looking at what happened between leaving here yesterday and coming back in this morning.

FRED

How did you get in this morning then?

STEVE

It was a nightmare. Gateshead just blocked. And it took, like, an hour.

FRED

Me the same. Of course the Satnav took me the busiest route.

STEVE

Yeah, it was crazy. I mean, of all days, of all days.

EDUCATOR

OK, I’m noticing that we’re all starting to talk over each other at the moment. Can we just listen to what Olga has to say? So what was your evening meal last night?

OLGA

OK. Where did I write it down? Here it is. I used the scales and the packets to work it out. I had five pieces of scampi and breadcrumbs. And they weighed …

FRED

I don’t like much fish, but I like scampi.

OLGA

The label said 22 …

STEVE

So you eat a lot of scampi?

OLGA

And they weighed 70 grams.

FRED

At least twice a week.

STEVE

Twice a week!

FRED

Yeah, I love it, man.

OLGA

The label said 22 grams per 100 grams.

FRED

You don’t like it that much?

STEVE

So how many times do you have it then? You got to treat yourself.

FRED

Yeah, you do have to treat yourself.

STEVE

Yeah. Yeah.

FRED

Worth every single time.

STEVE

So how many times do you …

FRED

You don’t even like scampi even with chips? Like …

EDUCATOR

Right. So we’re going to be looking at food labelling today and weighing out food. So this is really good practise for everybody.

FRED

No, no. Um, I, I really like scampi a lot, so …

EDUCATOR

OK, so I’m just getting a little bit conscious of time now, and we’ve still got Steve’s and Fred’s diary to look at. So let’s just focus on the CP counting for now. So let’s have a look at the CP list and see if we can work out what the CPs are for scampi and chips. So has everyone got their list? Fred, have you got your list?

FRED

Yeah.

EDUCATOR

That’s great.

[PHONE CHIMES]

Fred, would you be able to tell us what page scampi’s on, please?

FRED

Uh. 87.

EDUCATOR

Lovely. Thank you. So let’s have a little look at this then. OK. So Olga, talk us through how you worked your CPs out.

OLGA

Right. OK. I had 70 grams of scampi. There’s 22 grams per 100 grams.

FRED

[INAUDIBLE].

OLGA

So I divided 22 by 100.

[INTERPOSING VOICES]

Then multiplied by 70. And got 15 grams. Hm.

[SIDE CONVERSATION]

EDUCATOR

OK. So what does the CP list say, Fred?

FRED

Erm. It says the same.

EDUCATOR

Great. Thanks, Fred. OK, so Olga, what about your chips? How did you work them out?

OLGA

OK. So the chips weighed 120 grams and had 30 grams of carbs per 100 grams.

STEVE

You got to treat yourself.

FRED

Yeah, you do, got to treat yourself.

STEVE

Yeah.

OLGA

So then I did 30 divided by 100, multiplied by 120. That is 36. And then I added 36 grams and 15 grams and came up to 51 grams, which is 5 CPs.

EDUCATOR

OK. And what about the salad and the salad dressing?

OLGA

I didn’t count anything for that. It was just vegetables, and the dressing was just oil and vinegar, so no carbs.

FRED

I wouldn’t have done that. You can’t always weigh everything, can you? Sometimes you just have to have a look at it and guess. Dr Phillips says that it doesn’t have to be that accurate. As long as you’re somewhere near, your BG should be fine.

EDUCATOR

OK. What do you think about what Fred just said?

OLGA

Well, he’s right. You can’t always weigh everything, I mean, for example, if you’re in a restaurant. But I was at home, and I wanted to be sure. I made a mistake when counting my CPs yesterday at breakfast, and I had a hypo. And I don’t want that to happen again. And anyway, I’m learning at the moment, so I just want to be sure. Oh, no. I’ve just remembered. I had two Bakewell tart fingers after dinner, and I forgot to count them.

EDUCATOR

Oh, OK. And how many CPs were in those?

OLGA

One and a half, so that’s three.

EDUCATOR

So how much could three CPs raise BG by?

OLGA

Six to nine. So that’s why it was 13 at bedtime.

EDUCATOR

OK. What does everyone else think?

STEVE

Yeah.

DEAN

Sounds about right, yeah.

STEVE

Yeah, I agree.

EDUCATOR

Let’s take a look at the stepwise approach. We think that the BG was out of target because Olga forgot about three CPs. So CP counting is the problem here. Would there be anything else?

OLGA

No, I definitely think it’s about my CP counting. Mind, I haven’t done this before. Some of you are used to it. [SIGHS] I’m never going to get used to it at this rate. Honestly, I thought I was doing so well.

EDUCATOR

So you’re finding CP counting challenging at the moment. A lot of people do to begin with, but I wonder whether we should focus on what you got right instead of the mistake.

OLGA

Good idea. Well, how do you all find CP counting?

FRED

Well, it’s not that hard. I find the maths easy. You just made a silly mistake. Well, I mean, your counting was good apart from the mistake.

EDUCATOR

It’s not unusual to make mistakes, especially not at the beginning. In fact, mistakes can be helpful because they can help us to learn. I noticed that your CP counting was really accurate for those evening meals. Even the Bakewell tart. So if you had have had the insulin for those three CPs, what do you think your BG might have been?

OLGA

Well, in target, I suppose.

EDUCATOR

So what might you do next time?

OLGA

Get my CPs right.

EDUCATOR

Right. OK. Let’s have a little look at the next bit of the stepwise approach. This is the section on insulin. So do we think you might need to change your insulin with your evening meals?

OLGA

No. Honestly, I just think I need to get my CPs right first.

EDUCATOR

And what else happened last night?

OLGA

I set my alarm for 3:00 a.m.

FRED

You had a hypo at 3:00 a.m.

OLGA

When I checked, it was 4.0. So I had a carton of orange juice.

FRED

You only had two CPs at 4.0, that’s not nearly enough.

OLGA

And then went back to sleep.

FRED

I have to have a full fridge when I’m low.

DEAN

Sorry, I can’t hear what Olga’s saying. This is really important to me because I get hypos as well.

EDUCATOR

OK, it’s great that you’re all comfortable enough to throw your ideas into the pot, but this is one of those times that we just need to be reminded of the group agreement. Remember we said that we would listen and not talk over each other. Are we all OK sticking to the agreement? Good. It’s great that everybody’s comfortable. So just to sum up, Olga had a night time hypo. What would you like to do about that, Olga?

OLGA

Put my BI down by two units. I don’t want another one.

EDUCATOR

Great. Thanks, Olga. Right. So let’s have a look at Steve’s BG diary next.

End transcript

Download

 

Interactive feature not available in single page view (see it in standard view).

As you watch the video, think about:

Which educator behaviours can you observe being used to manage the challenging behaviour, keep group members engaged in the peer learning activity and the discussion on track?

If you need to refresh your memory about educator behaviour, refer to ‘Educator behaviours that demonstrate the DAFNE philosophy’, which is available in the resources area.

Record your observations in your workshop pack.

Part 2

Reflect on what you have observed. What will be different for you when you are in the room delivering face-to-face DAFNE courses? What might you have done differently? Record your reflections in your workshop pack.

Bring your observations and reflections to the workshop. You will have an opportunity to discuss them there.

In this video the educator is facilitating a session in which the group share their DAFNE diaries. In this session individuals are reflecting on their own application of DAFNE principles of CP estimation and insulin dose adjustment. They are looking for patterns in their Glucose to help them problem solve, make decisions and action plan for any changes they would like to make. The session is key to the DAFNE course and provides opportunities for modelling, mastery, reflection, experimentation and peer learning.

Activity 13: Negativity

Timing: 20 minutes

Part 1

Download this video clip.Video player: nc3612_dafne_2018_vid036.mp4

Show transcript|Hide transcript

Transcript

WOMAN

Nice cuppa.

[SIDE CONVERSATION]

OLGA

[voiceover] God, this is a waste of time. Yesterday was useless. I was just high all day and not in a good way. I don't think she can help me. This approach just seems daft.

EDUCATOR

Hello again, everyone. Shall we get straight back into it? OK, Olga, so before we look at your diary, would you like to just remind us of your action plan from last night?

OLGA

Look, yesterday was horrendous. I told you this wouldn't work. I was high all day. I mean, I know you mean well, but it's just pointless.

EDUCATOR

OK, I'm sorry to hear that. Could you just remind me what it was you said you would try last night?

OLGA

Well, we said if I was going to have supper, I should have some insulin with it.

EDUCATOR

OK, I think there was something else as well. What was that?

OLGA

OK, so we said I would check the BG in the night. I did, and it's just as bad in the morning. I mean, this is why I need a pump. It's just not working for me.

EDUCATOR

OK, so you're not happy with the numbers. What does everyone else think?

FRED

They look all right to me. They're not that bad. Better than mine, anyway. Apart from the 18 in the morning, they're all really steady.

OLGA

But then it went up overnight.

EDUCATOR

OK, well it sounds like that's the part of the day that you'd like to focus on for now. Shall we have a little look and see what's happening? Olga, can you please talk us through what happened between 10:30 last night and breakfast time this morning?

OLGA

OK, at 10:30 I checked, and they were 10.5. I had two CPs and took two units of insulin. I set the alarm at 3:30, 13.5. And this morning, 15, nightmare.

EDUCATOR

OK, so based on previous experience, what's a positive about your BG overnight? What hasn't happened since Monday?

OLGA

Well, I haven't had a hypo. But that doesn't mean I won't. I know how this happens.

EDUCATOR

So a positive is that you're using insulin in a new way. And, so far, you haven't had a hypo overnight this week. Looking at supper, what were the CPs there?

OLGA

Well, same as the night before. I had milk and biscuits, and they were the same.

EDUCATOR

And how did you work out the CPs for that?

OLGA

OK, I looked at the packet, 10 carbs. That's one CP. My glass of milk was a half pint, so that's half. I rounded it up to two, two CPs.

EDUCATOR

OK, so you rounded it up by half a CP. And how did it feel taking QA with supper?

OLGA

Well, odd. I've always eaten before to stop my BG dropping overnight.

EDUCATOR

Way back, we used to tell everyone to eat supper. That's quite a common thing to do. Who else, here, still does this?

FRED

I did. Then yesterday, when we talked about how insulin works, I thought, perhaps, I don't need to anymore. Maybe you don't either.

OLGA

Well, you're you, and I'm me. And everyone's different.

EDUCATOR

You're right, everyone is different. And that's why we need to work out what the right amount of insulin is for each individual person. That's why the course takes five days. So Olga, you've been trying lots of different things since Monday. So perhaps some of the things that were happening before might not be happening now. Did your BG drop overnight?

OLGA

No, it went up.

EDUCATOR

So what used to happen isn't happening at the moment. Thinking about the effect one CP has on BG, if you had those CPs without QA, what would happen to your BG?

OLGA

Well, it could have been even higher by this morning, maybe even 20, I suppose.

EDUCATOR

OK, so looking at what did happen, what do you think caused the rise?

OLGA

Well, I'm not sure. You tell me.

EDUCATOR

Fred, you mentioned yesterday's session on insulin. What do you think?

FRED

Well, if that was me, I'd think maybe my basal insulin wasn't high enough. The QA I'd take with supper would last about four hours we said. So by then, that's gone. So we've just got the BI working then.

EDUCATOR

And what does everybody else think?

[AFFIRMATIVE REACTIONS]

OLGA

So, QA with supper finished about 2:30. It's risen anyway despite the QA and rises even more by breakfast.

EDUCATOR

OK, so if we look at the stepwise approach in the workbook, Olga's identified the problem. Her BG is rising overnight. What about the other causes, Olga?

OLGA

Nope, no carbs, no alcohol. I didn't fancy taking extra as well as carbs, and my sites are OK.

EDUCATOR

OK, and do you think there's a pattern over 48 hours?

OLGA

Well, I suppose there is. It went up on Monday night as well.

STEVE

Yes, but you had two CPs without QA. That could've put you up by six.

EDUCATOR

OK, and what could help you decide that your BI at bedtime, you needed to change?

OLGA

OK, I suppose I could do the same again – have QA with my supper or just not have supper. I suppose I don't need it to keep my BG up. Oh dear, 3:00 a.m. again to do my checks, great.

EDUCATOR

And what does everyone else think?

[AFFIRMATIVE REACTIONS]

EDUCATOR

OK, Olga, it sounds like you've come up with an action plan for tonight. You just jot that down in your diary, and we might come back to it later. So your plan is to check the BI you take before bedtime by doing a 3:00 a.m. check. How do you think the changes you make are going to help you achieve your goal?

OLGA

Look, my goal is to get a pump. I really don't see how this is going to help.

EDUCATOR

OK, so we talked a little bit about pumps yesterday. When you use a pump, you still have to check that your basal insulin is right by doing checks through the night. The way we use insulin at DAFNE is very similar, so this may well help you in the future. Thank you very much, Olga.

Fred, shall we move on to your diary next?

End transcript

Download

 

Interactive feature not available in single page view (see it in standard view).

Which educator behaviours can you observe to manage the challenging behaviour, focus on the positives and involve the group?

If you need to refresh your memory about educator behaviours refer to ‘Educator behaviours that demonstrate the DAFNE philosophy’, which is available in the resources area

Record your observations in your workshop pack.

Reflect on what you have observed. What will be different for you when you are in the room delivering face-to-face DAFNE courses? What might you have done differently? Record your reflections in your workshop pack.

Bring your observations and reflections to the workshop. You will have an opportunity to discuss them there.

The content of this unit is now complete. Refer to your training handbook for information about the next steps in training. Please proceed to the end-of-unit knowledge assessment.

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Assal, J.P. and Golay, A. (2001) ‘Patient education in Switzerland: from diabetes to chronic disease’, Patient Education and Counselling, vol. 44, no. 1, pp. 65–69.

Bandura, A. (1971) Social Learning Theory, New York, General Learning Press.

Bates, B. (2016) Learning Theories Simplified, and How to Apply Them, London, Sage.

Brockett, R.G. (2015) Teaching Adults: A Practical Guide for New Teachers, San Francisco, Jossey-Bass.

Department of Business Innovation and Skills (2011) 2011 Skills for Life Survey: Headline Findings, London, Department of Business Innovation and Skills

Health Education England (2017) Health Literacy ‘How to’ Guide, London, Health Education England [Online]. Available at https://www.hee.nhs.uk/ our-work/ health-literacy (Accessed 29 October 2018).

Kolb, D.A. (1984) Experiential Learning, Englewood Cliffs, Prentice-Hall.

Knowles, M.S. (1990) The Adult Learner: A Neglected Species, 4th edn, Houston, Gulf Publishing.

Making It Easy: A Health Literacy Action Plan for Scotland, Crown © 2014 [Online]. Available at https://www2.gov.scot/ Resource/ 0045/ 00451263.pdf (Accessed 10 December 2018).

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