Case Studies

Case 5 With a colleague: peer discussion

Talking through a problem with someone who is able to listen fully can provide insights and clarity about how to deal with the problem in a new way. Dietitians who have these skills can give and receive support, and at the same time develop their competence in using counselling skills.

A dietitian gives support to a colleague

Tania specialises in diabetes. She comes into the office after a clinic and sits next to her colleague, Carol, who is sitting at her desk with her head in her hands. Carol is an experienced dietitian working in ICU. She has just had an appraisal interview with her manager, Ruth.

TANIA:	Hi, Carol. What’s up? Is anything wrong?
CAROL:	(gives a big sigh) I‘ve just been told I’ve got to go on a training course to learn how to be more patient–centred. I’ve got to research what courses are available, then discuss it with Ruth. I really don’t want to have to do all this. I can’t see the point when I’m working in ICU.
TANIA:	Oh, dear...You don’t see how such a course could be useful in your area of dietetics?
CAROL:	Well, these courses are about helping people change, aren’t they? They are for dietitians like you, not for me. My patients are often unconscious, so not up for talking! I spend most of my time calculating tube feeds and liaising with nursing and medical staff.
TANIA:	Mmhmm. As your patients are often unconscious, you’re thinking there’s no point in trying to communicate with them. I’m wondering, though, if their relatives ever need your help? Certainly the staff you work with do, so communications between you all have to be clearly understood.
CAROL:	Yes, of course. But I think I’m too old to learn new tricks, and I seem to have managed all right so far, so why now?
TANIA:	(laughs) Too old! Carol, I don’t believe that! Anyway, as you know, practising a patient-centred approach is what all of us need to aim for nowadays. I went on a course last year and found it very interesting and useful, although before I went I was pretty nervous. I’m wondering if that is how you feel now when you think about going?

The dietitian asks her colleague for support

CAROL:	(pauses, then nods her head slowly) Mm...You could be right. Maybe it would help if I knew more about it first. (Tania senses Carol needs time to consider, so remains silent. After a few seconds, Carol continues speaking) Perhaps you could tell me about the course you went on?
TANIA:	Yes. I‘d like to do that – it will be like a refresher for me! I‘ll look out my notes, as they might be useful for us both. Shall we arrange a time to do this?
CAROL:	That’s a good idea. Thanks for your help. (continues hesitantly) Maybe there’s something I can do for you sometime...
TANIA:	Well, actually, there is, since you mention it! Have you got a few minutes now?
CAROL:	Looks at her watch. Yes – I’ve got 5 minutes. Is that OK? (Tania nods) What’s it about?
TANIA:	Well, I’ve been asked to give this talk to students on feeding patients with head injuries –Ruth tells me no one else is available. It‘s such short notice, and I’m so out of date on this subject and I haven‘t got much time to read up about it. I’m feeling quite panicky.
CAROL:	Of course! That’s easy – I can give you the necessary information. But why didn’t Ruth ask me to do the talk?
TANIA:	I don’t know – it’d be easier for me if she had! Maybe you could ask her? Thanks a lot, though, for your offer of information – I really appreciate that. What I’m really worried about is that the students will ask me some awkward...
CAROL:	(interrupts) I certainly will ask her! Why didn’t she talk to me first?
TANIA:	I don’t know. But Carol, can I just finish...I was saying that I’m afraid the students will ask me some questions that I don’t know the answers to. I need to work out how to handle this.
CAROL:	(gives solution) You should tell them to go and look up the answer in the library!
TANIA:	Mm – I think I need to think about some alternatives...Let me think...
CAROL:	(jumps in quickly) You should have some references in a hand out and tell them the answer will be in one of these.
TANIA:	Carol – I know you‘re trying to help, but can you just give me time to think...(speaks slowly) A few ideas are coming into my mind now, such as...if I repeat the question first, I can make sure I‘ve understood what it is, and this also acknowledges the person who asked it. (begins to speak more quickly, sounding quite excited) Then, if I still don‘t know the answer, I could ask if anyone in the room has any ideas. We may then get a discussion going...Yes, that way feels more comfortable for me. I think it‘s best if I don‘t pretend to be the expert right from the start, but explain I‘m standing in at the last minute. Then I‘ll tell them what I‘ve learned with the help of your information and focus on ways of involving them, so we come up with possible solutions to some real situations. It‘ll be a challenge, but I‘m quite excited about it now! Thanks for your help.
CAROL:	(shrugs her shoulders slightly, speaks slowly) I’m not sure if I have helped you yet...but I’ll get the information on tube feeds for you.
TANIA:	Thanks – that will be very useful. And I’ll look out my counselling skills course notes for you. I’m glad we’ve both had a chance to talk. Let’s arrange another time to meet.

You are recommended to use the book and video...

To read about listening and responding (Chapters 6 and 7).

To read about giving and receiving support (Chapter 16).

To watch skilled support being given to a dietitian by a colleague (Scene 3).